Healthcare Provider Details

I. General information

NPI: 1801871819
Provider Name (Legal Business Name): FAIROOZ KABBINAVAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 LE CONTE AVE SUITE # 2338 J / PVUB 957187
LOS ANGELES CA
90095-3000
US

IV. Provider business mailing address

10945 LE CONTE AVE SUITE # 2338 J / PVUB 957187
LOS ANGELES CA
90095-3000
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3921
  • Fax: 310-267-0151
Mailing address:
  • Phone: 310-206-3921
  • Fax: 310-267-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA 45968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: