Individual
AMIR K. GHIASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 W STEWART DR, ORANGE, CA 92868-3849
(714) 633-9111
Mailing address
24422 AVENIDA DE LA CARLOTA STE 275, LAGUNA HILLS, CA 92653-3669
(949) 829-8299
(949) 829-8298
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
C52272
CA
207RP1001X
Pulmonary Disease Physician
C52272
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
NPI - TYPE 2
—
05
—
1912919804
—
CA
01
—
CG5665
RAIL ROAD MEDICARE - GROUP PTAN
CA
01
—
P00348140
RAIL ROAD MEDICARE - PROVIDER PTAN
CA
01
—
W1514
MEDICARE PTAN - TYPE 2
CA
Enumeration date
07/13/2006
Last updated
04/09/2018
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