Provider Demographics
NPI:1780066225
Name:SARRAFPOUR, SOSHIAN (MD)
Entity type:Individual
Prefix:DR
First Name:SOSHIAN
Middle Name:
Last Name:SARRAFPOUR
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 1:9058 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1306
Mailing Address - Country:US
Mailing Address - Phone:626-487-1710
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST STE 1B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-21
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63584207W00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program