Provider Demographics
NPI:1366419426
Name:ESHAGHPOUR, ESHAGH ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:ESHAGH
Middle Name:ISAAC
Last Name:ESHAGHPOUR
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:P.O. BOX 18061
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-4061
Mailing Address - Country:US
Mailing Address - Phone:310-855-9055
Mailing Address - Fax:310-855-9011
Practice Address - Street 1:8631 W. THIRD STREET
Practice Address - Street 2:SUITE 444E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-855-9055
Practice Address - Fax:310-855-9011
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC505692080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5890835OtherMEDI-CAL
CA00C50569Medicaid
CA00C50569Medicaid