Provider Demographics
NPI:1033498548
Name:FARBOD ESMAILIAN, M.D., INC.
Entity type:Organization
Organization Name:FARBOD ESMAILIAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FARBOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESMAILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-430-7373
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-430-7373
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-430-7373
Practice Address - Fax:951-272-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74047208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74047OtherCA MEDICAL LICENSE
CAI71828Medicare UPIN
CABA875AMedicare PIN