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General NPI Number Information
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NPI Number | 1164726436
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Entity Type | Organization
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Legal Business Name | MEHRYAR TABAN MD INC
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 9735 WILSHIRE BLVD. SUITE 204
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City | BEVERLY HILLS
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State | CA
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Zip | 90212
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Country | US
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Telephone | 310-278-1836
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Fax | 310-278-1828
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Provider Business Mailing Address
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Address Line | 9735 WILSHIRE BLVD. SUITE 204
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City | BEVERLY HILLS
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State | CA
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Zip | 90212
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Country | US
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Telephone | 310-278-1836
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Fax | 310-278-1828
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEHRYAR TABAN
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Credential | M.D.
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Telephone | 310-278-1836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A99093
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License Number State | CA
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