Basic Information
| Provider Information | |||||||||
| NPI: | 1760423123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARHADI | ||||||||
| FirstName: | ASHKAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17360 BROOKHURST ST | ||||||||
| Address2: | ATTN: NETWORK MANAGEMENT | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572413592 | ||||||||
| FaxNumber: | 7146654614 | ||||||||
| Practice Location | |||||||||
| Address1: | 722 BAKER ST | ||||||||
| Address2: | MEMORIAL CARE MEDICAL GROUP | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926264320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149669523 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 05/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | C 53536 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.