Active NPI
Siamak Agha Mohammadi, M.D.
- Specialist
- Corona del Mar, CA
National Provider Identifier
1871675033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A92742
- Practice address
- 2121 E Coast Hwy Ste 260
Corona del Mar, CA 92625-1932 - Phone
- (949) 644-2442
- Fax
- (949) 644-2518
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD426291 | PA | |
| Specialist | 174400000X | A92742 | CA | Primary |
Addresses
Primary practice location
2121 E Coast Hwy Ste 260
Corona del Mar, CA 92625-1932
Mailing address
2121 E Coast Hwy Ste 260
Corona del Mar, CA 92625-1932
Phone (949) 644-2442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A92742 | CA | MD | Specialist |
| MD426291 | PA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305590400000",
"number": "1871675033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 E COAST HWY STE 260",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926251932",
"telephone_number": "949-644-2442",
"fax_number": "949-644-2518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 E COAST HWY STE 260",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926251932",
"telephone_number": "949-644-2442",
"fax_number": "949-644-2518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGHA MOHAMMADI",
"first_name": "SIAMAK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2011-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "MD426291",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A92742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona del Mar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.