Provider Demographics
NPI:1750399622
Name:ESHOM, JAMES LOUIS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:ESHOM
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 1:406 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3829
Mailing Address - Country:US
Mailing Address - Phone:626-445-9661
Mailing Address - Fax:626-446-9508
Practice Address - Street 1:406 S. FIRST AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-0000
Practice Address - Country:US
Practice Address - Phone:626-445-9661
Practice Address - Fax:626-446-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A452291Medicaid
A29799Medicare UPIN
CA00A452291Medicaid