MEDICARE: FARBOD YOUSHEI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	110064	CA
2	183500000X	Pharmacist	81777	CA

General Provider Information

NPI Number	:	1336764562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARBOD YOUSHEI

Provider Business Mailing Address
First Line	:	1905 GRANVILLE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2052 S BUNDY DR # 1151
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6102
Country	:	US
Telephone Number	:	818-378-3809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	05/10/2024

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Directions to “ FARBOD YOUSHEI ” Practice Location

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