Provider Demographics
NPI:1487695433
Name:NIKBAKHT, FARSHEED (MD)
Entity type:Individual
Prefix:DR
First Name:FARSHEED
Middle Name:
Last Name:NIKBAKHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KHODABAKHSH
Other - Middle Name:
Other - Last Name:NIKBAKHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,BCEM ,FAAFP
Mailing Address - Street 1:1521 GREENFIELD AVE
Mailing Address - Street 2:APT. # 304
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3422
Mailing Address - Country:US
Mailing Address - Phone:310-435-2864
Mailing Address - Fax:
Practice Address - Street 1:1521 GREENFIELD AVE
Practice Address - Street 2:APT. # 304
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3422
Practice Address - Country:US
Practice Address - Phone:310-435-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485140Medicaid
WA48514LMedicare PIN
CAF29610Medicare UPIN