Provider Demographics
NPI:1861786873
Name:DEHKORDI, BEHRANG HOSSEINI (MD)
Entity type:Individual
Prefix:
First Name:BEHRANG
Middle Name:HOSSEINI
Last Name:DEHKORDI
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 1:28241 CROWN VALLEY PKWY STE F312
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:646-525-2210
Mailing Address - Fax:
Practice Address - Street 1:12 MAUCHLY STE P
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-6309
Practice Address - Country:US
Practice Address - Phone:949-354-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138910207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine