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Organization

ADVANCED OB/GYN & INFERTILITY MEDICAL GROUP INC

Active
Other names
ADVANCED OB/GYN MEDICAL GROUP
Organization subpart
No

Provider details

NPI number
Authorized official
KAMRAN GHODSIAN MD (PRESIDENT)
(949) 362-1515
Entity
Organization

Contact information

Practice address
24502 PACIFIC PARK DR, SUITE 105, ALISO VIEJO, CA 92656-3033
(949) 362-1515
(949) 362-7548
Mailing address
24502 PACIFIC PARK DR, SUITE 105, ALISO VIEJO, CA 92656-3033
(949) 362-1515
(949) 362-7548

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0050350
CA
05
GR0050351
CA
01
ZZZ29048Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
08/31/2006
Last updated
03/22/2011
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