Provider Demographics
NPI:1184724643
Name:VAKILI, FAYEGH (MD)
Entity type:Individual
Prefix:DR
First Name:FAYEGH
Middle Name:
Last Name:VAKILI
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 1:4477 W 118TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2259
Mailing Address - Country:US
Mailing Address - Phone:310-644-3500
Mailing Address - Fax:310-644-0877
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-644-3500
Practice Address - Fax:310-644-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39870207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954032272OtherTAX ID NO.
CAA28985Medicare UPIN