Provider Demographics
NPI:1033112313
Name:ESLAMI, BAHRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHRAM
Middle Name:
Last Name:ESLAMI
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 1:700 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3602
Mailing Address - Country:US
Mailing Address - Phone:714-245-1444
Mailing Address - Fax:714-953-6604
Practice Address - Street 1:700 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3602
Practice Address - Country:US
Practice Address - Phone:714-245-1444
Practice Address - Fax:714-953-6604
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060039694OtherRAILROAD MEDICARE
CAW13988OtherMEDICARE PTAN
CAW13988AOtherMEDICARE PTAN
CADB3373OtherRAILROAD MEDICARE
CAW13988AOtherMEDICARE PTAN
CAW13988OtherMEDICARE PTAN