Provider Demographics
NPI:1497993356
Name:YAGHMAIE, FARZIN (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:FARZIN
Middle Name:
Last Name:YAGHMAIE
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 1176
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-689-8363
Mailing Address - Fax:310-494-0387
Practice Address - Street 1:9663 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 1176
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4303
Practice Address - Country:US
Practice Address - Phone:310-689-8363
Practice Address - Fax:310-494-0387
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1065642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG591XMedicare PIN
CADG591YMedicare PIN