Provider Demographics
NPI:1639330954
Name:GHANDFOROUSH, ASLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ASLAN
Middle Name:
Last Name:GHANDFOROUSH
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 1:5945 TRUXTUN EXTENSION
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0610
Mailing Address - Country:US
Mailing Address - Phone:661-631-5544
Mailing Address - Fax:661-631-5546
Practice Address - Street 1:5945 TRUXTUN EXTENSION
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0610
Practice Address - Country:US
Practice Address - Phone:661-631-5544
Practice Address - Fax:661-631-5546
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13941207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA207R00000XOtherMEDICARE TAXONOMY
CA161609OtherMEDICARE PTAN
CAP01543877OtherMEDICARE RAILROAD PTAN
CA1639330954Medicaid