Provider Demographics
NPI:1164500211
Name:FARSHIDI, HOOSHANG DEAH (MD)
Entity Type:Individual
Prefix:
First Name:HOOSHANG
Middle Name:DEAH
Last Name:FARSHIDI
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 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE #303
Mailing Address - City:W COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-856-3686
Mailing Address - Fax:626-856-3684
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE #303
Practice Address - City:W COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-856-3686
Practice Address - Fax:626-856-3684
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology