Provider Demographics
NPI:1710904651
Name:MALEKMEHR, FARSHAD (MD)
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:MALEKMEHR
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:PO BOX 492293
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8293
Mailing Address - Country:US
Mailing Address - Phone:818-343-5109
Mailing Address - Fax:818-343-8770
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:SUITE # 208
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-782-3255
Practice Address - Fax:818-782-7026
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83840208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG83840BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
CAG57298Medicare UPIN
CAWG83840AMedicare ID - Type UnspecifiedMEDICARE PROVIDER N.