=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972538890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BIJAN FARAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 09/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17130 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-385-1300
-----------------------------------------------------
Fax | 818-385-1395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 260496
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91426-0496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-385-1300
-----------------------------------------------------
Fax | 818-385-1395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A35772
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------