Provider Demographics
NPI:1932376514
Name:ARDESHIRPOUR, FARHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:ARDESHIRPOUR
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 1:6 BORMES
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0234
Mailing Address - Country:US
Mailing Address - Phone:919-244-8938
Mailing Address - Fax:
Practice Address - Street 1:150 S RODEO DR STE 260
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2445
Practice Address - Country:US
Practice Address - Phone:424-242-8608
Practice Address - Fax:424-242-0410
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132714204E00000X, 207N00000X, 207ND0101X, 207NS0135X, 207WX0200X, 207YS0123X, 208200000X, 2082S0099X
WAMD60365940207YS0123X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1932376514Medicaid
WA8918689Medicare PIN