Provider Demographics
NPI:1518138338
Name:FOROUTAN, FARZAD
Entity Type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:FOROUTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 KNOTT AVE
Mailing Address - Street 2:SUITE #L
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4108
Mailing Address - Country:US
Mailing Address - Phone:714-826-4181
Mailing Address - Fax:714-826-4488
Practice Address - Street 1:8951 KNOTT AVE
Practice Address - Street 2:SUITE #L
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4108
Practice Address - Country:US
Practice Address - Phone:714-826-4181
Practice Address - Fax:714-826-4488
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist