Individual
DR. JACK J FARAHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 E HARDY ST, STE 200, INGLEWOOD, CA 90301-4057
(310) 672-3900
(310) 671-8438
Mailing address
501 E HARDY ST, STE 200, INGLEWOOD, CA 90301-4057
(310) 672-3900
(310) 671-8438
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G67763
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G677630
—
CA
01
—
95-4170981
GROUP PROVIDER ID
CA
01
—
G67763
MEDICAL LICENSE
CA
Enumeration date
06/23/2005
Last updated
11/10/2021
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