Healthcare Provider Details

I. General information

NPI: 1558756650
Provider Name (Legal Business Name): FARYAN JALALABADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR
BEVERLY HILLS CA
90210-4409
US

IV. Provider business mailing address

433 N CAMDEN DR
BEVERLY HILLS CA
90210-4409
US

V. Phone/Fax

Practice location:
  • Phone: 310-620-2111
  • Fax: 310-620-2110
Mailing address:
  • Phone: 310-620-2111
  • Fax: 310-620-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA170884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: