Provider Demographics
NPI:1689492209
Name:AMIN ESFAHANI M.D. CORPORATION
Entity type:Organization
Organization Name:AMIN ESFAHANI M.D. CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESFAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-306-6613
Mailing Address - Street 1:2801 GREWAL PKWY APT 533
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8018
Mailing Address - Country:US
Mailing Address - Phone:646-306-6613
Mailing Address - Fax:
Practice Address - Street 1:1390 W H ST STE A
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3529
Practice Address - Country:US
Practice Address - Phone:209-755-7546
Practice Address - Fax:209-444-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA172964OtherSTATE LICENSE