Provider Demographics
NPI:1447249040
Name:FARHOOMAND, KAVEH (DO)
Entity type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:FARHOOMAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 WARING CT
Mailing Address - Street 2:STE G
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4510
Mailing Address - Country:US
Mailing Address - Phone:760-758-3830
Mailing Address - Fax:760-758-9139
Practice Address - Street 1:3231 WARING CT
Practice Address - Street 2:STE G
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-758-3830
Practice Address - Fax:760-758-9139
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX82950Medicaid
CAH83292Medicare UPIN
CA00AX82950Medicaid