Organization Active NPI

Farough Kerendi MD Inc

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1528134558
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A40018 Issued in CA
Legal business name
FAROUGH KERENDI MD INC
Practice address
6360 Wilshire Blvd
Suite 414
Los Angeles, CA 90048-5603
Phone
(323) 655-1930
Fax
(323) 655-1377
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Authorized official

Name
Farough Kerendi, MDNPI 1568538593
Title
Owner
Phone
(323) 655-1930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X A40018 CA Primary

Addresses

Primary practice location

6360 Wilshire Blvd
Suite 414
Los Angeles, CA 90048-5603

Mailing address

6360 Wilshire Blvd
Suite 414
Los Angeles, CA 90048-5603
Phone (323) 655-1930

Other identifiers 1

IdentifierTypeStateIssuer
00A400181MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080529000349 CA Part B Supplier - Clinic/Group Practice 0143390450 Receives reassigned benefits from 2 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

4636 Fountain Ave
Los Angeles, CA 90029
Phone (323) 913-4830

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1528134558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 414",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485603",
            "telephone_number": "323-655-1930",
            "fax_number": "323-655-1377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 414",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485603",
            "telephone_number": "323-655-1930",
            "fax_number": "323-655-1377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAROUGH KERENDI MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "KERENDI",
        "authorized_official_first_name": "FAROUGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-655-1930",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A40018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A400181",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.