Provider Demographics
NPI:1205130663
Name:FARZAD, KATHY (DDS)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:FARZAD
Suffix:
Gender:F
Credentials:DDS
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 7539
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-7539
Mailing Address - Country:US
Mailing Address - Phone:310-286-0265
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 915
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3710
Practice Address - Country:US
Practice Address - Phone:310-286-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice