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General NPI Number Information
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NPI Number | 1922414101
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Entity Type | Organization
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Legal Business Name | FARI G KAMALPOUR DO INC
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1049 AVENIDA LADERA
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City | SAN DIMAS
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State | CA
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Zip | 91773-4308
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Country | US
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Telephone | 818-730-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 AVENIDA LADERA
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City | SAN DIMAS
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State | CA
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Zip | 91773-4308
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Country | US
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Telephone | 818-730-1183
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARI G KAMALPOUR
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Credential | DO
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Telephone | 818-730-1183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A11842
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License Number State | CA
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