Healthcare Provider Details

I. General information

NPI: 1174553424
Provider Name (Legal Business Name): BABAK FARDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

PO BOX 51055
LOS ANGELES CA
90051-5355
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8068
  • Fax: 714-456-3765
Mailing address:
  • Phone: 714-456-8068
  • Fax: 714-456-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA84646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: