Provider Demographics
NPI:1487234316
Name:MEHDI FAKHRAI MD, F.I.C.S., F.A.C.S., MEDICAL CORPORATION
Entity type:Organization
Organization Name:MEHDI FAKHRAI MD, F.I.C.S., F.A.C.S., MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-898-3939
Mailing Address - Street 1:10605 BALBOA BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6376
Mailing Address - Country:US
Mailing Address - Phone:818-898-3939
Mailing Address - Fax:818-898-1663
Practice Address - Street 1:10605 BALBOA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6376
Practice Address - Country:US
Practice Address - Phone:818-898-3939
Practice Address - Fax:818-898-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty