Provider Demographics
NPI:1730405440
Name:GVOZDYEV, BORYS (MD)
Entity type:Individual
Prefix:
First Name:BORYS
Middle Name:
Last Name:GVOZDYEV
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 1:17870 NEWHOPE ST STE 104-197
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5439
Mailing Address - Country:US
Mailing Address - Phone:949-342-8892
Mailing Address - Fax:
Practice Address - Street 1:18035 BROOKHURST ST STE 1200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6738
Practice Address - Country:US
Practice Address - Phone:949-988-0000
Practice Address - Fax:949-988-4000
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144225207X00000X, 207XS0117X
KY47717207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE