Provider Demographics
NPI:1477673598
Name:FOROUZANPOUR, FARDAD (DO)
Entity Type:Individual
Prefix:DR
First Name:FARDAD
Middle Name:
Last Name:FOROUZANPOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3108
Mailing Address - Country:US
Mailing Address - Phone:310-360-0504
Mailing Address - Fax:310-360-6246
Practice Address - Street 1:8500 WILSHIRE BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3108
Practice Address - Country:US
Practice Address - Phone:310-360-0504
Practice Address - Fax:310-360-6246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7188208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery