Healthcare Provider Details

I. General information

NPI: 1972553576
Provider Name (Legal Business Name): BABAK B ABRISHAMI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE SUITE 902
LOS ANGELES CA
90027-6005
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: 323-913-9140

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:
Title or Position:
Credential:
Phone: