Provider Demographics
NPI:1114287497
Name:RAD, SHERVIN FOULADI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:FOULADI
Last Name:RAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERVIN
Other - Middle Name:
Other - Last Name:FOULADI RAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17360 BROOKHURST STREET
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9122 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3405
Practice Address - Country:US
Practice Address - Phone:714-378-0900
Practice Address - Fax:714-378-5166
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1601207Q00000X
390200000X
CAA135003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program