Healthcare Provider Details

I. General information

NPI: 1033112313
Provider Name (Legal Business Name): BAHRAM ESLAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

IV. Provider business mailing address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-1444
  • Fax: 714-953-6604
Mailing address:
  • Phone: 714-245-1444
  • Fax: 714-953-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC42075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: