Provider Demographics
NPI:1427012228
Name:FAKHRAI, MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:FAKHRAI
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 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:STE 360
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1252
Mailing Address - Country:US
Mailing Address - Phone:818-898-3939
Mailing Address - Fax:818-898-1663
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:STE 360
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1252
Practice Address - Country:US
Practice Address - Phone:818-898-3939
Practice Address - Fax:818-898-3939
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39658208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A396580Medicaid
CAA39658Medicare ID - Type Unspecified
CA00A396580Medicaid