Provider Demographics
NPI:1437332954
Name:FARHAD MELAMED M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FARHAD MELAMED M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-8585
Mailing Address - Street 1:150 N ROBERTSON BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2121
Mailing Address - Country:US
Mailing Address - Phone:310-657-8585
Mailing Address - Fax:310-657-8484
Practice Address - Street 1:150 N ROBERTSON BLVD STE 115
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2121
Practice Address - Country:US
Practice Address - Phone:310-657-8585
Practice Address - Fax:310-657-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19633Medicare PIN