Healthcare Provider Details

I. General information

NPI: 1346388600
Provider Name (Legal Business Name): FARZIN KERENDIAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 607
LOS ANGELES CA
90067-2009
US

IV. Provider business mailing address

PO BOX 10464
BEVERLY HILLS CA
90213-3464
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-4900
  • Fax: 310-613-6137
Mailing address:
  • Phone: 310-274-4900
  • Fax: 661-327-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A7647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number20A7647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: