Healthcare Provider Details

I. General information

NPI: 1831180314
Provider Name (Legal Business Name): FARZIN A MOUSAVI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WILSHIRE BLVD STE 909
LOS ANGELES CA
90048-5810
US

IV. Provider business mailing address

6200 WILSHIRE BLVD STE 909
LOS ANGELES CA
90048-5810
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-2770
  • Fax:
Mailing address:
  • Phone: 310-714-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: