Provider Demographics
NPI:1780751693
Name:AJIR, FARROUKH (MD)
Entity type:Individual
Prefix:DR
First Name:FARROUKH
Middle Name:
Last Name:AJIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARR
Other - Middle Name:
Other - Last Name:AJIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3448 WHITERIVER PL
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5517
Mailing Address - Country:US
Mailing Address - Phone:818-879-9348
Mailing Address - Fax:818-879-9358
Practice Address - Street 1:1240 WESTLAKE BLVD
Practice Address - Street 2:SUITE #121
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:818-879-9348
Practice Address - Fax:818-879-9358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37062207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A370620Medicaid
ND10629Medicaid
CA00A370620Medicaid