Healthcare Provider Details

I. General information

NPI: 1801374251
Provider Name (Legal Business Name): FARAZ FARAHNIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 730
ENCINO CA
91436-2260
US

IV. Provider business mailing address

9707 HORNER ST
LOS ANGELES CA
90035-2812
US

V. Phone/Fax

Practice location:
  • Phone: 818-658-9285
  • Fax:
Mailing address:
  • Phone: 310-500-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number102704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: