Provider Demographics
NPI:1568538593
Name:KERENDI, FAROUGH (MD)
Entity Type:Individual
Prefix:
First Name:FAROUGH
Middle Name:
Last Name:KERENDI
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 1:6360 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5603
Mailing Address - Country:US
Mailing Address - Phone:323-655-1930
Mailing Address - Fax:323-655-1377
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5603
Practice Address - Country:US
Practice Address - Phone:323-655-1930
Practice Address - Fax:323-655-1377
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40018208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A400181Medicaid
CAB50416Medicare UPIN
CA00A400181Medicaid