Genetic Institute of Anti Aging

Primary specialty

Ph.D. Medical GeneticsTaxonomy code 170100000X

License

G77981 Issued in CA

Legal business name

GENETIC INSTITUTE OF ANTI AGING

Practice address

720 Paularino Ave
Suite 100
Costa Mesa, CA 92626-2940

Phone

(714) 641-2640

Fax

(714) 641-2646

NPI assigned

Apr 2, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mohammad Saeed Kharazmi, MD

Title

Medical Director

Phone

(714) 641-2640

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750402574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PAULARINO AVE",
            "address_2": "SUITE 100",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926262940",
            "telephone_number": "714-641-2640",
            "fax_number": "714-641-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PAULARINO AVE",
            "address_2": "SUITE 100",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926262940",
            "telephone_number": "714-641-2640",
            "fax_number": "714-641-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENETIC INSTITUTE OF ANTI AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHARAZMI",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "SAEED",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "714-641-2640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "CA",
            "license": "G77981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ph.D. Medical Genetics in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Ph.D. Medical Genetics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.