Provider Demographics
NPI:1740485101
Name:NIKOO, FARHAD GHASEMI (NP)
Entity type:Individual
Prefix:
First Name:FARHAD
Middle Name:GHASEMI
Last Name:NIKOO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:FARHAD
Other - Middle Name:
Other - Last Name:GHASEMI-NIKOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 6040
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-6040
Mailing Address - Country:US
Mailing Address - Phone:714-769-6090
Mailing Address - Fax:
Practice Address - Street 1:2082 BUSINESS CENTER DR STE 255
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1162
Practice Address - Country:US
Practice Address - Phone:714-769-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726112163W00000X
CA18138363LF0000X, 363LP0808X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ085ZMedicare PIN
CABJ123ZMedicare PIN
CABJ123YMedicare PIN