Provider Demographics
NPI:1669589750
Name:SIEGEL, HOWARD S (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19065
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-9065
Mailing Address - Country:US
Mailing Address - Phone:714-904-8017
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-908-5636
Practice Address - Fax:714-908-5616
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501830Medicaid
CA00A501830Medicaid
CA00A501830Medicaid