Provider Demographics
NPI:1023129665
Name:ELHAM ELLE FARAJIAN, DPM, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ELHAM ELLE FARAJIAN, DPM, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:ELLE
Authorized Official - Last Name:FARAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-842-7277
Mailing Address - Street 1:17822 BEACH BLVD STE 437
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6835
Mailing Address - Country:US
Mailing Address - Phone:714-842-7277
Mailing Address - Fax:714-841-8387
Practice Address - Street 1:17822 BEACH BLVD STE 437
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7181
Practice Address - Country:US
Practice Address - Phone:714-842-7277
Practice Address - Fax:714-842-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4550213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6679360001Medicare NSC