Healthcare Provider Details

I. General information

NPI: 1124923222
Provider Name (Legal Business Name): ALLIYAH FARAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N CANON DR
BEVERLY HILLS CA
90210-3326
US

IV. Provider business mailing address

606 N CANON DR
BEVERLY HILLS CA
90210-3326
US

V. Phone/Fax

Practice location:
  • Phone: 310-913-9121
  • Fax:
Mailing address:
  • Phone: 310-913-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: