Healthcare Provider Details

I. General information

NPI: 1366885345
Provider Name (Legal Business Name): ARTUR FAHRADYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 HAMPSHIRE RD STE 1
WESTLAKE VILLAGE CA
91361-2833
US

IV. Provider business mailing address

911 HAMPSHIRE RD STE 1
WESTLAKE VILLAGE CA
91361-2833
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9891
  • Fax:
Mailing address:
  • Phone: 805-885-0801
  • Fax: 805-885-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA137921
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number256519
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: