Healthcare Provider Details

I. General information

NPI: 1568091841
Provider Name (Legal Business Name): BEHNAM FARIDIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E WILLIAMS ST STE 102
BANNING CA
92220-5808
US

IV. Provider business mailing address

304 S JONES BLVD # 402
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-6794
  • Fax:
Mailing address:
  • Phone: 310-801-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA184266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23299
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: