Provider Demographics
NPI:1245558105
Name:FAGHFOORY, AMIR POOYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:POOYAN
Last Name:FAGHFOORY
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 1:27281 LAS RAMBLAS STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8303
Mailing Address - Country:US
Mailing Address - Phone:310-367-2532
Mailing Address - Fax:
Practice Address - Street 1:27281 LAS RAMBLAS STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8303
Practice Address - Country:US
Practice Address - Phone:310-367-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1122322084P0800X
MDD851912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGY445ZMedicare PIN