Provider Demographics
NPI:1912369414
Name:DREAM ANESTHESIA, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DREAM ANESTHESIA, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:KYUREGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-767-3951
Mailing Address - Street 1:5 HOLLAND STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:5 HOLLAND STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2568
Practice Address - Country:US
Practice Address - Phone:949-588-2190
Practice Address - Fax:949-588-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123012207L00000X
CA20A12069207L00000X
CAA106152207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty