Provider Demographics
NPI:1134154594
Name:FARJAMI, SASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SASSAN
Middle Name:
Last Name:FARJAMI
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1043 ELM AVE
Practice Address - Street 2:STE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3244
Practice Address - Country:US
Practice Address - Phone:562-590-0345
Practice Address - Fax:562-437-8139
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94020207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A940200Medicaid
CAWA94020BMedicare PIN
CAWA94020AMedicare PIN
CAI61367Medicare UPIN