Provider Demographics
NPI:1235792581
Name:YAZDANPANAH, OMID (MD)
Entity type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:YAZDANPANAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMID
Other - Middle Name:
Other - Last Name:BAGHAL YAZDANPANAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3220
Mailing Address - Country:US
Mailing Address - Phone:714-456-5172
Mailing Address - Fax:
Practice Address - Street 1:200 S MANCHESTER AVE STE 400
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3220
Practice Address - Country:US
Practice Address - Phone:714-456-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA179046207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology