Provider Demographics
NPI:1659316156
Name:MOBIN, FARDAD (MD)
Entity Type:Individual
Prefix:
First Name:FARDAD
Middle Name:
Last Name:MOBIN
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 1:120 S SPALDING DR STE 305
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1800
Mailing Address - Country:US
Mailing Address - Phone:310-829-8888
Mailing Address - Fax:310-943-2636
Practice Address - Street 1:120 S SPALDING DR STE 305
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:310-829-8888
Practice Address - Fax:310-943-2636
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61426174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16001Medicare ID - Type Unspecified
CAH43613Medicare UPIN