Provider Demographics
NPI:1912000811
Name:FARAJI, ESHAGH ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ESHAGH
Middle Name:ISAAC
Last Name:FARAJI
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:PO BOX 3166
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-3166
Mailing Address - Country:US
Mailing Address - Phone:209-667-0543
Mailing Address - Fax:209-667-0613
Practice Address - Street 1:1729 N. OLIVE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-667-0543
Practice Address - Fax:209-667-0613
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78778207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A787780OtherMEDI-CAL
00A787780OtherMEDI-CAL
CAH75214Medicare UPIN