Provider Demographics
NPI:1518034115
Name:JAHANPANAH, FERESHTEH (MD)
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:
Last Name:JAHANPANAH
Suffix:
Gender:F
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:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92022-1622
Mailing Address - Country:US
Mailing Address - Phone:619-447-6001
Mailing Address - Fax:619-447-6096
Practice Address - Street 1:343 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3942
Practice Address - Country:US
Practice Address - Phone:619-447-6001
Practice Address - Fax:619-447-6096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65104Medicare ID - Type Unspecified
E83426Medicare UPIN
CA00G651040Medicaid