Provider Demographics
NPI:1700888690
Name:AFSAHI, VINCE FERHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCE
Middle Name:FERHAD
Last Name:AFSAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 WALNUT AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6935
Mailing Address - Country:US
Mailing Address - Phone:714-508-0754
Mailing Address - Fax:174-508-5754
Practice Address - Street 1:2552 WALNUT AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6935
Practice Address - Country:US
Practice Address - Phone:714-508-0754
Practice Address - Fax:174-508-5754
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67614207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033241138OtherSOUTH COAST DERMATOLOGY NPI
CAW16844Medicare ID - Type UnspecifiedSOUTH COAST DERM. INST.