Provider Demographics
NPI:1922054527
Name:FARAJIAN, ELHAM ELLE (DPM)
Entity Type:Individual
Prefix:MS
First Name:ELHAM
Middle Name:ELLE
Last Name:FARAJIAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 437
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-842-7277
Mailing Address - Fax:714-841-8387
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 437
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-842-7277
Practice Address - Fax:714-841-8387
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4550213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA922Medicare UPIN
CAW19083Medicare ID - Type Unspecified