Provider Demographics
NPI:1538265830
Name:JAVADI, FARIBA (MD)
Entity type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:JAVADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DOWNEY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1470
Mailing Address - Country:US
Mailing Address - Phone:562-634-4939
Mailing Address - Fax:562-634-5809
Practice Address - Street 1:5750 DOWNEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1470
Practice Address - Country:US
Practice Address - Phone:562-634-4939
Practice Address - Fax:562-634-5809
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-131172207R00000X
CAA97057207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18762OtherGROUP MEDICARE
CA1902846306OtherGROUP NPI
IL036131172Medicaid
CAGR0100430OtherGROUP MEDICAL
IL256510146Medicare PIN