Provider Demographics
NPI:1205370749
Name:AMIR FAGHFOORY, MD, APC
Entity Type:Organization
Organization Name:AMIR FAGHFOORY, MD, APC
Other - Org Name:THE PSYCH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:POOYAN
Authorized Official - Last Name:FAGHFOORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-367-2532
Mailing Address - Street 1:12304 SANTA MONICA BLVD
Mailing Address - Street 2:334
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-367-2532
Mailing Address - Fax:310-820-8031
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:334
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-367-2532
Practice Address - Fax:310-820-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1122322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty