Basic Information
| Provider Information | |||||||||
| NPI: | 1427076272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSHIAR | ||||||||
| FirstName: | ALLEN | ||||||||
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| Credential: | DO, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 VINTAGE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926203409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148784812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 E CHAPMAN AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928693204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146283300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A8021 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.