Provider Demographics
NPI:1225775612
Name:FARHAD, KEYVAN (ND)
Entity Type:Individual
Prefix:DR
First Name:KEYVAN
Middle Name:
Last Name:FARHAD
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY STE 155
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3163
Mailing Address - Country:US
Mailing Address - Phone:949-612-9090
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 155
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3163
Practice Address - Country:US
Practice Address - Phone:949-612-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86016431133V00000X
CAND1333175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered