Fariba Kezel, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY20295 Issued in CA

Practice address

4199 Campus Dr
Suite 550
Irvine, CA 92612-4696

Phone

(714) 490-4965

Fax

(949) 509-6599

NPI assigned

Feb 17, 2007

Last updated

Dec 2, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Fariba Ebrahim Khan Khezel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291248000000",
    "number": "1912041484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4199 CAMPUS DR",
            "address_2": "SUITE 550",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926124696",
            "telephone_number": "714-490-4965",
            "fax_number": "949-509-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 CAMPUS DR",
            "address_2": "SUITE 550",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926124696",
            "telephone_number": "714-490-4965",
            "fax_number": "949-509-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEZEL",
        "first_name": "FARIBA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-17",
        "last_updated": "2010-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY20295",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20295",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FARIBA",
            "last_name": "EBRAHIM KHAN KHEZEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Neuropsychologist in Irvine, CA
• Providers in Irvine, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; 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.