Provider Demographics
NPI:1679621726
Name:ZARDOUZ, BIJAN (MD)
Entity type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:ZARDOUZ
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 28017
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-8017
Mailing Address - Country:US
Mailing Address - Phone:714-540-2272
Mailing Address - Fax:714-540-7206
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3650
Practice Address - Country:US
Practice Address - Phone:714-540-2272
Practice Address - Fax:714-540-7206
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38367207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A383670Medicaid
CA038367Medicare ID - Type Unspecified
CAA38367Medicare PIN
CA00A383670Medicaid