Healthcare Provider Details

I. General information

NPI: 1124090576
Provider Name (Legal Business Name): STEVEN W TABAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N CAMDEN DR STE 1100
BEVERLY HILLS CA
90210-4532
US

IV. Provider business mailing address

414 N CAMDEN DR STE 1100
BEVERLY HILLS CA
90210-4532
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-3400
  • Fax: 310-278-1240
Mailing address:
  • Phone: 310-278-3400
  • Fax: 310-278-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG37598
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG37598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: