NPIMap

Individual provider Active NPI

Peyman Kabolizadeh

  • Radiation Oncology Physician
  • Fountain Valley, CA
National Provider Identifier
1093941171
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
A152224 Issued in CA
Practice address
18111 Brookhurst St Ste Ll0300
Fountain Valley, CA 92708-6728
Phone
(714) 962-7100
NPI assigned
Jun 3, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X VA
Radiation Oncology Physician 2085R0001X A152224 CA Primary

Addresses

Primary practice location

18111 Brookhurst St Ste Ll0300
Fountain Valley, CA 92708-6728

Mailing address

PO Box 844945
Los Angeles, CA 90084-4945

Other identifiers 1

IdentifierTypeStateIssuer
0F34985OtherMIBCBSM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200827002605 CA Practitioner - Radiation Oncology 8022236561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Virginia Commonwealth University, School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Radiation Oncology MedicalGroup PAC ID 6103049937, 5 clinicians

Practice addresses (Care Compare)

18111 Brookhurst St
Ll0300
Fountain Valley, CA 92708-6728
Phone (714) 962-7100

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

Merit-based Incentive Payment System (MIPS)

Final score
85.23 of 100Reported as group
Quality
69.8
Improvement activities
40
Cost
75.77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Radiation Oncology Medical Radiation Oncology Current Accepting new patients
Memorial Radiation Oncology Medical Radiation Oncology CurrentSince Oct 1, 2020 Accepting new patients
Memorial Radiation Oncology Medical Radiation Oncology CurrentSince Oct 1, 2020 Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients

Locations

18111 Brookhurst St
Ste LL300
Fountain Valley, CA 92708
Phone (714) 962-7100

18111 Brookhurst St
#300
Fountain Vly, CA 92708
Phone (714) 880-8200

24302 Paseo de Valencia
Laguna Hills, CA 92653
Phone (949) 452-8880

2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: pkabolizadeh641273@direct.memorialcare.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1093941171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844945",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900844945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18111 BROOKHURST ST STE LL0300",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-962-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KABOLIZADEH",
        "first_name": "PEYMAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-03",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "A152224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0F34985",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.