1710161567 NPI number — FARJAD SARAFIAN, MD, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710161567 NPI number — FARJAD SARAFIAN, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARJAD SARAFIAN, MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710161567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4521 CAMPUS DR
Provider Second Line Business Mailing Address:
SUITE 366
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-940-8092
Provider Business Mailing Address Fax Number:
949-340-0109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27800 MEDICAL CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-940-8092
Provider Business Practice Location Address Fax Number:
949-340-0109
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARAFIAN
Authorized Official First Name:
FARJAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-940-8092

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  A72530 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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