Provider Demographics
NPI:1851847156
Name:FARID DIDARI DPM PC
Entity Type:Organization
Organization Name:FARID DIDARI DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-625-9797
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3583
Mailing Address - Country:US
Mailing Address - Phone:310-625-9797
Mailing Address - Fax:
Practice Address - Street 1:5050 SAN BERNARDINO ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2326
Practice Address - Country:US
Practice Address - Phone:310-625-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5242213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty