Healthcare Provider Details

I. General information

NPI: 1689803090
Provider Name (Legal Business Name): PARVAZ FARNAD, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E OCEAN BLVD 503
LONG BEACH CA
90802-5012
US

IV. Provider business mailing address

600 E OCEAN BLVD 503
LONG BEACH CA
90802-5012
US

V. Phone/Fax

Practice location:
  • Phone: 310-617-0144
  • Fax: 310-652-0984
Mailing address:
  • Phone: 310-617-0144
  • Fax: 310-652-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number53062
License Number StateCA

VIII. Authorized Official

Name: DR. PARVAZ FARNAD
Title or Position: PRESIDENT
Credential: DDS, MPH
Phone: 310-617-0144