Healthcare Provider Details

I. General information

NPI: 1801418702
Provider Name (Legal Business Name): FARZAD ALEMI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 E IMPERIAL HWY STE 103
LYNWOOD CA
90262-2600
US

IV. Provider business mailing address

PO BOX 363
REDONDO BEACH CA
90277-0363
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-5010
  • Fax: 310-900-5019
Mailing address:
  • Phone: 310-900-5010
  • Fax: 310-900-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARZAD ALEMI
Title or Position: PRESIDENT
Credential: MD
Phone: 949-338-0970