Provider Demographics
NPI:1164509139
Name:FAYEGH VAKILI INC
Entity Type:Organization
Organization Name:FAYEGH VAKILI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYEGH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-644-3500
Mailing Address - Street 1:4477 W 118TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2255
Mailing Address - Country:US
Mailing Address - Phone:310-644-9500
Mailing Address - Fax:310-644-0877
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-644-9500
Practice Address - Fax:310-644-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28985Medicare UPIN
CAA39870Medicare ID - Type Unspecified