Healthcare Provider Details

I. General information

NPI: 1427012228
Provider Name (Legal Business Name): MEHDI FAKHRAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD STE 360
MISSION HILLS CA
91345-1252
US

IV. Provider business mailing address

11550 INDIAN HILLS RD STE 360
MISSION HILLS CA
91345-1252
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-3939
  • Fax: 818-898-3939
Mailing address:
  • Phone: 818-898-3939
  • Fax: 818-898-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA39658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: