MEDICARE: DR. FARZIN YAGHMAIE M.D., M.A.

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	2084P0800X	Psychiatry Physician	A106564	CA

General Provider Information

NPI Number	:	1497993356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARZIN YAGHMAIE M.D., M.A.

Provider Business Mailing Address
First Line	:	9663 SANTA MONICA BLVD
Second Line	:	SUITE 1176
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	310-689-8363
Fax Number	:	310-494-0387

Provider Business Practice Location Address
First Line	:	9663 SANTA MONICA BLVD
Second Line	:	SUITE 1176
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	310-689-8363
Fax Number	:	310-494-0387

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/06/2015

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