=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437557360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FARA SALEHI D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2014
-----------------------------------------------------
Last Update Date | 12/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18740 VENTURA BLVD SUITE #105
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-342-2000
-----------------------------------------------------
Fax | 818-708-8000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18740 VENTURA BLVD SUITE #105
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-342-2000
-----------------------------------------------------
Fax | 818-708-8000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 36608
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------