Provider Demographics
NPI:1821145426
Name:FARHANGFAR, KAMYAR (MD)
Entity Type:Individual
Prefix:
First Name:KAMYAR
Middle Name:
Last Name:FARHANGFAR
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 1:1015 RILEY ST UNIT 6241
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-4101
Mailing Address - Country:US
Mailing Address - Phone:916-458-5435
Mailing Address - Fax:
Practice Address - Street 1:400 PLAZA DR STE 160
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4746
Practice Address - Country:US
Practice Address - Phone:916-458-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA192780OtherMEDICARE PTAN
CA00A624780Medicare ID - Type Unspecified