Provider Demographics
NPI:1376590471
Name:HOURIANI, FARHAD (MD)
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:HOURIANI
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:PO BOX 7328
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7328
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:10767 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602
Practice Address - Country:US
Practice Address - Phone:818-301-6700
Practice Address - Fax:818-301-6701
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA609732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A609730Medicaid
CA00A609730OtherBLUE SHIELD
CAWA60973IMedicare PIN
CAP00244932Medicare PIN
CA00A609730OtherBLUE SHIELD
H46138Medicare UPIN
CAWA60973EMedicare PIN