Provider Demographics
NPI:1598092330
Name:FARNAM, KEVIN SAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SAMAN
Last Name:FARNAM
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 1:65 N MADISON AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5248
Mailing Address - Country:US
Mailing Address - Phone:626-793-2246
Mailing Address - Fax:844-272-2073
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:STE 202
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5248
Practice Address - Country:US
Practice Address - Phone:626-793-2246
Practice Address - Fax:844-272-2073
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 110001207R00000X
CAA110001207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB257447Medicare UPIN