Provider Demographics
NPI:1992004055
Name:SAHAFI, FRED
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:SAHAFI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FEREYDOUN
Other - Middle Name:
Other - Last Name:SAHAFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7916 EASTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5461
Mailing Address - Country:US
Mailing Address - Phone:562-928-7060
Mailing Address - Fax:562-928-7090
Practice Address - Street 1:7916 EASTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-5461
Practice Address - Country:US
Practice Address - Phone:562-928-7060
Practice Address - Fax:562-928-7090
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist