Provider Demographics
NPI:1790855955
Name:DANA, FARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:DANA
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 1:2350 BUHNE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3238
Mailing Address - Country:US
Mailing Address - Phone:707-441-1911
Mailing Address - Fax:707-441-4843
Practice Address - Street 1:2350 BUHNE ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3238
Practice Address - Country:US
Practice Address - Phone:707-441-1911
Practice Address - Fax:707-441-4843
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84390207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK265ZMedicare PIN
CAH98708Medicare UPIN
CA00A843900Medicare PIN