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NPI Code Detail

MEDICARE: FARNAM AHMADI MOSHTAGHIN

MEDICARE: FARNAM AHMADI MOSHTAGHIN
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
1122300000XDentist104741CA

General Provider Information

NPI Number : 1972142040
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARNAM AHMADI MOSHTAGHIN
Provider Business Mailing Address
First Line : 17145 SW OAK ST
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-3920
Country : US
Telephone Number : 503-962-9182
Fax Number :
Provider Business Practice Location Address
First Line : 3870 BROAD ST STE 1
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7172
Country : US
Telephone Number : 805-214-4071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2020
Last Update Date : 01/06/2020

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Directions to “ FARNAM AHMADI MOSHTAGHIN ” Practice Location

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