Healthcare Provider Details

I. General information

NPI: 1497969448
Provider Name (Legal Business Name): FARNAZ TOFIGH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 W PICO BLVD
LOS ANGELES CA
90015-2407
US

IV. Provider business mailing address

1561 W PICO BLVD
LOS ANGELES CA
90015-2407
US

V. Phone/Fax

Practice location:
  • Phone: 213-251-9994
  • Fax: 213-251-9796
Mailing address:
  • Phone: 213-251-9994
  • Fax: 213-251-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: