Healthcare Provider Details

I. General information

NPI: 1619646007
Provider Name (Legal Business Name): DR. YOURAM FARZAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10394 ROCHESTER AVE
LOS ANGELES CA
90024-5357
US

IV. Provider business mailing address

10394 ROCHESTER AVE
LOS ANGELES CA
90024-5357
US

V. Phone/Fax

Practice location:
  • Phone: 310-800-3408
  • Fax:
Mailing address:
  • Phone: 310-800-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number106594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: