Provider Demographics
NPI:1366527491
Name:BABAKNIA, ARDALAN (MD)
Entity type:Individual
Prefix:
First Name:ARDALAN
Middle Name:
Last Name:BABAKNIA
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 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3145
Mailing Address - Country:US
Mailing Address - Phone:949-753-8844
Mailing Address - Fax:949-753-0181
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3145
Practice Address - Country:US
Practice Address - Phone:949-753-8844
Practice Address - Fax:949-753-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44193207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
03682770OtherECFMG
CAA44193OtherSTATE LICENSE
CABKO141565OtherDEA
CAE48100Medicare UPIN