Provider Demographics
NPI:1689943946
Name:PANTEA FARHADI MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PANTEA FARHADI MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOROUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-3750
Mailing Address - Street 1:8635 W 3RD ST STE 1065W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6105
Mailing Address - Country:US
Mailing Address - Phone:310-483-9843
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 1065W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4120
Practice Address - Country:US
Practice Address - Phone:818-708-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1050572084P0800X, 283Q00000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicare PIN