Provider Demographics
NPI:1205611050
Name:FAHRADYAN PLASTIC SURGERY
Entity type:Organization
Organization Name:FAHRADYAN PLASTIC SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHRADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-626-4006
Mailing Address - Street 1:911 HAMPSHIRE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2833
Mailing Address - Country:US
Mailing Address - Phone:805-885-0801
Mailing Address - Fax:805-885-0802
Practice Address - Street 1:911 HAMPSHIRE RD STE 1
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2833
Practice Address - Country:US
Practice Address - Phone:805-885-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty