Provider Demographics
NPI:1740611821
Name:FARZAD JACOB KHOUBIAN, MD INC.
Entity Type:Organization
Organization Name:FARZAD JACOB KHOUBIAN, MD INC.
Other - Org Name:ADVANCED EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:KHOUBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-430-2345
Mailing Address - Street 1:1026 W WEST COVINA PKWY
Mailing Address - Street 2:#B
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-8204
Mailing Address - Country:US
Mailing Address - Phone:626-593-4234
Mailing Address - Fax:626-956-0555
Practice Address - Street 1:1026 W WEST COVINA PKWY
Practice Address - Street 2:#B
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-8204
Practice Address - Country:US
Practice Address - Phone:626-593-4234
Practice Address - Fax:626-956-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95916207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty