Provider Demographics
NPI:1558310003
Name:FARZAD, SHAHRIAR (MD)
Entity type:Individual
Prefix:
First Name:SHAHRIAR
Middle Name:
Last Name:FARZAD
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 1:415 N CRESCENT DR STE 225
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6809
Mailing Address - Country:US
Mailing Address - Phone:310-247-8282
Mailing Address - Fax:310-247-1418
Practice Address - Street 1:415 N CRESCENT DR STE 225
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6809
Practice Address - Country:US
Practice Address - Phone:310-247-8282
Practice Address - Fax:310-247-1418
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI53662Medicare UPIN
CAW19844Medicare PIN