MEDICARE: FAROUGH KERENDI MD INC

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	208D00000X	General Practice Physician	A40018	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528134558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAROUGH KERENDI MD INC

Provider Business Mailing Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:	SUITE 414
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-655-1930
Fax Number	:	323-655-1377

Provider Business Practice Location Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:	SUITE 414
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-655-1930
Fax Number	:	323-655-1377

Authorized Official
Title or Position	:	OWNER
Name	:	FAROUGH KERENDI
Credential	:	MD
Telephone Number	:	323-655-1930

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/10/2015

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Directions to “FAROUGH KERENDI MD INC ” Practice Location

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