MEDICARE: FERESHTEH JAHANPANAH M.D., A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G65104	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396082517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERESHTEH JAHANPANAH M.D., A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1626
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92022-1626
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

Provider Business Practice Location Address
First Line	:	343 E MAIN ST STE 101
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3942
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHARLENE ANNE WULFF
Credential	:
Telephone Number	:	619-312-7049

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2025

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