Provider Demographics
NPI:1912176264
Name:DR. M. FORGHANI S. C
Entity Type:Organization
Organization Name:DR. M. FORGHANI S. C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGHANI-ARANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-537-1387
Mailing Address - Street 1:12665 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1901
Mailing Address - Country:US
Mailing Address - Phone:714-537-1387
Mailing Address - Fax:714-537-0917
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-537-1387
Practice Address - Fax:714-537-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
CA20A8699261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX86991Medicaid
CAW17279OtherGROUP MEDICARE ID NUMBER
CA00AX86991Medicaid
ILH56008Medicare UPIN