Provider Demographics
NPI:1679540116
Name:DEHKORDI, REZA HOSSEINI (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:HOSSEINI
Last Name:DEHKORDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REZA
Other - Middle Name:H
Other - Last Name:DEHKORDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 315
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8039
Mailing Address - Country:US
Mailing Address - Phone:949-364-6000
Mailing Address - Fax:949-364-1204
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-6000
Practice Address - Fax:949-364-1204
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD36414207R00000X
CAC54677208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8250383Medicaid
WAG97324Medicare UPIN
CAFG492YMedicare PIN
WA8250383Medicaid
CAFG492ZMedicare PIN