MEDICARE: FARZIN R FARHAN DDS 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	261QD0000X	Dental Clinic/Center	42467	CA

General Provider Information

NPI Number	:	1942486667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARZIN R FARHAN DDS INC

Provider Business Mailing Address
First Line	:	2822 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3032
Country	:	US
Telephone Number	:	323-734-9600
Fax Number	:	323-734-9300

Provider Business Practice Location Address
First Line	:	2822 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3032
Country	:	US
Telephone Number	:	323-734-9600
Fax Number	:	323-734-9300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARZIN R FARHAN
Credential	:	DDS
Telephone Number	:	323-734-9600

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	07/07/2016

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