Provider Demographics
NPI:1821092685
Name:GHAFFARI, SASAN (MD)
Entity Type:Individual
Prefix:
First Name:SASAN
Middle Name:
Last Name:GHAFFARI
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 1:23521 PASEO DE VALENCIA STE 303
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3102
Mailing Address - Country:US
Mailing Address - Phone:949-837-6600
Mailing Address - Fax:949-837-6602
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 303
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3102
Practice Address - Country:US
Practice Address - Phone:949-837-6600
Practice Address - Fax:949-837-6602
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87173207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease