Provider Demographics
NPI:1780839472
Name:JEHANGIR YEGANEH, MD, INC
Entity Type:Organization
Organization Name:JEHANGIR YEGANEH, MD, INC
Other - Org Name:GEHANGUIR YEGANEH, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEGANEH,
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-948-0754
Mailing Address - Street 1:44725 10TH ST W STE 130
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3051
Mailing Address - Country:US
Mailing Address - Phone:661-948-0754
Mailing Address - Fax:661-948-1156
Practice Address - Street 1:44725 10TH ST W STE 130
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3051
Practice Address - Country:US
Practice Address - Phone:661-948-0754
Practice Address - Fax:661-948-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30192207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301920Medicaid
CAA30192Medicare PIN
CAA87315Medicare UPIN