NPIMap

Organization Active NPI

Farwest Dental Group, PC

  • Dental Clinic/Center
  • Wilmington, CA
National Provider Identifier
1023598836
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
52604 Issued in CA
Legal business name
FARWEST DENTAL GROUP, PC
Practice address
1704 N Avalon Blvd
Wilmington, CA 90744-1433
Phone
(310) 835-5030
Fax
(310) 835-6090
NPI assigned
Aug 21, 2018
Last updated
Aug 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hassan Fayoumi, DDSNPI 1831269489
Title
Ceo
Phone
(310) 699-1549

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 52604 CA Primary
Dental Clinic/Center 261QD0000X 50718 CA

Addresses

Primary practice location

1704 N Avalon Blvd
Wilmington, CA 90744-1433

Mailing address

1704 N Avalon Blvd
Wilmington, CA 90744-1433
Phone (310) 835-5030

Other practice location 1

1315 N Bullis Rd
Compton, CA 90221-1650
Phone (424) 338-3060

Other practice location 2

8880 S Broadway
Los Angeles, CA 90003-3635
Phone (323) 758-6768

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534809600000",
    "number": "1023598836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441433",
            "telephone_number": "310-835-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441433",
            "telephone_number": "310-835-5030",
            "fax_number": "310-835-6090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 N Bullis Rd",
            "address_purpose": "LOCATION",
            "city": "Compton",
            "state": "CA",
            "postal_code": "902211650",
            "country_code": "US",
            "telephone_number": "424-338-3060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8880 S Broadway",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900033635",
            "country_code": "US",
            "telephone_number": "323-758-6768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FARWEST DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-21",
        "last_updated": "2018-08-21",
        "status": "A",
        "authorized_official_last_name": "FAYOUMI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-699-1549",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "52604",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "50718",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.