Healthcare Provider Details

I. General information

NPI: 1932620812
Provider Name (Legal Business Name): IMAN ABDEL BAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 HARBOR BLVD UNIT A
COSTA MESA CA
92627-2630
US

IV. Provider business mailing address

2077 HARBOR BLVD UNIT A
COSTA MESA CA
92627-2630
US

V. Phone/Fax

Practice location:
  • Phone: 949-675-6759
  • Fax:
Mailing address:
  • Phone: 949-675-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72354
License Number StateCA

VIII. Authorized Official

Name: DR. IMAN ABDEL BAR
Title or Position: MD
Credential: A72354
Phone: 949-675-6759