Provider Demographics
NPI:1770526360
Name:GOLDSTEIN, STEPHEN MYRON (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MYRON
Last Name:GOLDSTEIN
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 1:431 N TUSTIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3821
Mailing Address - Country:US
Mailing Address - Phone:949-273-7300
Mailing Address - Fax:714-644-0225
Practice Address - Street 1:431 N TUSTIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:949-273-7300
Practice Address - Fax:714-644-0225
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG26456GMedicare ID - Type UnspecifiedMEDICARE RENDERING NUMBER
CAW17355Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAB51029Medicare UPIN