Provider Demographics
NPI:1407261217
Name:ESFAHANI, AMIN (MD)
Entity type:Individual
Prefix:DR
First Name:AMIN
Middle Name:
Last Name:ESFAHANI
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 1:2801 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:209-444-6634
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
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172964207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology