Provider Demographics
NPI:1932125382
Name:FARAJI, JAMSHID (MD)
Entity Type:Individual
Prefix:
First Name:JAMSHID
Middle Name:
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 1:6620 COYLE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6338
Mailing Address - Country:US
Mailing Address - Phone:916-965-8161
Mailing Address - Fax:916-965-8782
Practice Address - Street 1:6620 COYLE AVE STE 402
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6338
Practice Address - Country:US
Practice Address - Phone:916-965-8161
Practice Address - Fax:916-965-8782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500240Medicaid
CA00A500242Medicare PIN
CA00A500240Medicaid