Healthcare Provider Details

I. General information

NPI: 1922054527
Provider Name (Legal Business Name): ELHAM ELLE FARAJIAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD STE 355
HUNTINGTON BEACH CA
92647-6854
US

IV. Provider business mailing address

17742 BEACH BLVD STE 355
HUNTINGTON BEACH CA
92647-6854
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-7277
  • Fax: 714-907-4754
Mailing address:
  • Phone: 714-842-7277
  • Fax: 714-907-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: