# VEIN DOCTOR MEDICAL GROUP INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164699880
- **Authorized official:** MS. KIMBERLEY SHARIFI (CREDENTIALING MANAGER)
- **Authorized official phone:** (714) 500-7714

## Contact information

- **Practice address:** 1945 E 17TH ST STE 107, SANTA ANA, CA 92705-6862
- **Practice address phone:** (714) 500-7714
- **Practice address fax:** (714) 500-7713
- **Mailing address:** 1945 E 17TH ST STE 107, SANTA ANA, CA 92705-6862
- **Mailing address phone:** (714) 500-7714
- **Mailing address fax:** (714) 500-7713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | G35672 | CA | Yes |

## Other

- **Enumeration date:** 05/12/2008
- **Last updated:** 10/22/2021