Provider Demographics
NPI:1750405270
Name:DR. KAVEH S FARHOOMAND
Entity type:Organization
Organization Name:DR. KAVEH S FARHOOMAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARHOOMAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-758-3830
Mailing Address - Street 1:3231 WARING CT
Mailing Address - Street 2:SUITE G
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4510
Mailing Address - Country:US
Mailing Address - Phone:760-758-3830
Mailing Address - Fax:760-758-9139
Practice Address - Street 1:3231 WARING CT
Practice Address - Street 2:SUITE G
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-758-3830
Practice Address - Fax:760-758-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX82950Medicaid
CA20A8295Medicare ID - Type Unspecified
CA00AX82950Medicaid