Healthcare Provider Details

I. General information

NPI: 1346690138
Provider Name (Legal Business Name): MICHAEL FARHANGIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15503 VENTURA BLVD STE 240
ENCINO CA
91436-3162
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-461-8148
  • Fax: 818-461-8105
Mailing address:
  • Phone: 310-301-8771
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA167882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: