Provider Demographics
NPI:1073505764
Name:YASHARPOUR, FARID (MD)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:YASHARPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14671 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4199
Mailing Address - Country:US
Mailing Address - Phone:818-270-9030
Mailing Address - Fax:818-270-9039
Practice Address - Street 1:14671 RINALDI ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4199
Practice Address - Country:US
Practice Address - Phone:818-270-9030
Practice Address - Fax:818-270-9039
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065312208000000X
CAA65312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA653120OtherP10
H60183Medicare UPIN