Provider Demographics
NPI:1295766434
Name:YEGANEH, JEHANGIR (MD)
Entity type:Individual
Prefix:DR
First Name:JEHANGIR
Middle Name:
Last Name:YEGANEH
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 1:44725 10TH ST W STE 130
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3051
Mailing Address - Country:US
Mailing Address - Phone:661-948-0754
Mailing Address - Fax:661-948-1156
Practice Address - Street 1:44725 10TH ST W
Practice Address - Street 2:SUITE 130
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3033
Practice Address - Country:US
Practice Address - Phone:661-948-0754
Practice Address - Fax:661-948-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30192207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301920Medicaid
CAA87315Medicare UPIN
CAA30192Medicare PIN
CAA30192Medicare ID - Type Unspecified