Healthcare Provider Details

I. General information

NPI: 1790815082
Provider Name (Legal Business Name): LOS ANGELES LUNG CENTER A PROFESSIONAL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE STE 902
LOS ANGELES CA
90027-6094
US

IV. Provider business mailing address

PO BOX 480481
LOS ANGELES CA
90048-1481
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-9130
  • Fax: 323-913-9140
Mailing address:
  • Phone: 323-913-9130
  • Fax: 213-977-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A7450
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK BOB ABRISHAMI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 323-913-9130