Provider Demographics
NPI:1962694869
Name:SHOKOOHY, FARIBA (MD)
Entity type:Individual
Prefix:MRS
First Name:FARIBA
Middle Name:
Last Name:SHOKOOHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1811
Mailing Address - Country:US
Mailing Address - Phone:714-436-4716
Mailing Address - Fax:714-619-8770
Practice Address - Street 1:1002 N FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-1811
Practice Address - Country:US
Practice Address - Phone:714-835-8501
Practice Address - Fax:714-619-8770
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93966208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice