Healthcare Provider Details

I. General information

NPI: 1295259976
Provider Name (Legal Business Name): FARHAD KHOUJINIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HOWARD ST
SAN FRANCISCO CA
94103-2638
US

IV. Provider business mailing address

1301 IRVING STREET APT # 221
SAN FRANCISCO CA
94122
US

V. Phone/Fax

Practice location:
  • Phone: 415-255-3788
  • Fax:
Mailing address:
  • Phone: 415-568-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: