Healthcare Provider Details

I. General information

NPI: 1689943946
Provider Name (Legal Business Name): PANTEA FARHADI MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 1065W
LOS ANGELES CA
90048-4120
US

IV. Provider business mailing address

8635 W 3RD ST STE 1065W
LOS ANGELES CA
90048-6105
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-3750
  • Fax:
Mailing address:
  • Phone: 310-483-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SOROUR KHALILI
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 818-708-3750