Provider Demographics
NPI:1972538890
Name:FARAH, BIJAN (MD)
Entity type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:FARAH
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:PO BOX 260496
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0496
Mailing Address - Country:US
Mailing Address - Phone:818-385-1300
Mailing Address - Fax:818-385-1395
Practice Address - Street 1:17130 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4003
Practice Address - Country:US
Practice Address - Phone:818-385-1300
Practice Address - Fax:818-385-1395
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357720Medicaid
CA00A357720Medicaid
CAD13747Medicare UPIN