Healthcare Provider Details

I. General information

NPI: 1184724643
Provider Name (Legal Business Name): FAYEGH VAKILI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W 118TH ST SUITE 503
HAWTHORNE CA
90250-2255
US

IV. Provider business mailing address

4477 W 118TH ST STE 405
HAWTHORNE CA
90250-2259
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-3500
  • Fax: 310-644-0877
Mailing address:
  • Phone: 310-644-3500
  • Fax: 310-644-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA39870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: