Provider Demographics
NPI:1104929777
Name:MICHAEL KERMANI, MD, INC
Entity type:Organization
Organization Name:MICHAEL KERMANI, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-640-2010
Mailing Address - Street 1:P O BOX 10711
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658
Mailing Address - Country:US
Mailing Address - Phone:949-640-2010
Mailing Address - Fax:949-640-2090
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-640-2010
Practice Address - Fax:949-640-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013010685OtherNPI PERSONAL
CA00A750090Medicaid
CAW18838Medicare ID - Type Unspecified
H47530Medicare UPIN