Healthcare Provider Details

I. General information

NPI: 1598092330
Provider Name (Legal Business Name): KEVIN SAMAN FARNAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE STE 202
PASADENA CA
91101-5248
US

IV. Provider business mailing address

65 N MADISON AVE STE 202
PASADENA CA
91101-5248
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-2246
  • Fax: 844-272-2073
Mailing address:
  • Phone: 626-793-2246
  • Fax: 844-272-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA 110001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA110001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: