Provider Demographics
NPI:1144223926
Name:NAVID, FARIBA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:NAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 WILSHIRE BLVD
Mailing Address - Street 2:600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2804
Mailing Address - Country:US
Mailing Address - Phone:323-361-2337
Mailing Address - Fax:323-361-8491
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4100
Practice Address - Fax:323-361-3642
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN369802080P0207X
CAC1456962080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010092931Medicaid
AL009907875Medicaid
NV100508087Medicaid
NJ0030988Medicaid
IN200402850AMedicaid
ME422400000Medicaid
MS00126768Medicaid
OK200000440AMedicaid
LA1140899Medicaid
TX168488802Medicaid
MO205962103Medicaid
IA0569723Medicaid
OH0879723Medicaid
MI104677740Medicaid
AR148329001Medicaid
TN3496570Medicaid
KY64059389Medicaid
TN3496570Medicaid