Healthcare Provider Details

I. General information

NPI: 1659454841
Provider Name (Legal Business Name): BABAK BARCOHANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE
VAN NUYS CA
91405-3730
US

IV. Provider business mailing address

6815 NOBLE AVE
VAN NUYS CA
91405-3730
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax: 818-997-7826
Mailing address:
  • Phone: 818-901-6600
  • Fax: 818-997-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA78880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA78880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: