Provider Demographics
NPI:1649328519
Name:AZIZOLLAHI, FARID (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:AZIZOLLAHI
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 1:8920 WILSHIRE BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2002
Mailing Address - Country:US
Mailing Address - Phone:310-421-8835
Mailing Address - Fax:310-421-8435
Practice Address - Street 1:8920 WILSHIRE BLVD STE 335
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2002
Practice Address - Country:US
Practice Address - Phone:310-421-8835
Practice Address - Fax:310-421-8435
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A833530Medicaid
CA00A833530Medicaid