Provider Demographics
NPI:1447313754
Name:GAON, AVRO (MD)
Entity type:Individual
Prefix:DR
First Name:AVRO
Middle Name:
Last Name:GAON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8729
Mailing Address - Country:US
Mailing Address - Phone:949-640-4115
Mailing Address - Fax:949-640-4143
Practice Address - Street 1:1401 AVOCADO AVE STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8729
Practice Address - Country:US
Practice Address - Phone:949-640-4115
Practice Address - Fax:949-640-4143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA033404261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84469Medicare UPIN