Healthcare Provider Details

I. General information

NPI: 1356548358
Provider Name (Legal Business Name): FARSHID SEAN FAHID D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 208
BEVERLY HILLS CA
90210-4312
US

IV. Provider business mailing address

11701 MONTANA AVE APT 403
LOS ANGELES CA
90049-4735
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-4411
  • Fax: 310-274-9288
Mailing address:
  • Phone: 310-770-9000
  • Fax: 310-274-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: