Provider Demographics
NPI:1497829972
Name:FARAHANCHI, ARASH (DO)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:FARAHANCHI
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 1:2251 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2601
Mailing Address - Country:US
Mailing Address - Phone:714-449-6230
Mailing Address - Fax:
Practice Address - Street 1:2251 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2601
Practice Address - Country:US
Practice Address - Phone:714-449-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9462207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX94620Medicaid
CAW20A9462AMedicare PIN
CAHJ569ZMedicare PIN
CA020A94620Medicare PIN
CA00AX94620Medicaid