Healthcare Provider Details

I. General information

NPI: 1487695433
Provider Name (Legal Business Name): FARSHEED NIKBAKHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KHODABAKHSH NIKBAKHT M.D.,BCEM ,FAAFP

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 GREENFIELD AVE APT. # 304
LOS ANGELES CA
90025-3422
US

IV. Provider business mailing address

1521 GREENFIELD AVE APT. # 304
LOS ANGELES CA
90025-3422
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-2864
  • Fax:
Mailing address:
  • Phone: 310-435-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA48514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: