Healthcare Provider Details

I. General information

NPI: 1902348816
Provider Name (Legal Business Name): HOUMAN FARZIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 WILSHIRE BLVD STE 105
SANTA MONICA CA
90403-4901
US

IV. Provider business mailing address

2467 N CATALINA ST
LOS ANGELES CA
90027-1130
US

V. Phone/Fax

Practice location:
  • Phone: 310-526-7619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA140627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA140627
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA140627
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number288325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: