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General NPI Number Information
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NPI Number | 1255376638
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Entity Type | Organization
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Legal Business Name | SHAHRAM TABIB MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 1300 NORTH VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-913-4892
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Fax |
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Provider Business Mailing Address
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Address Line | 8581 SANTA MONICA BLVD #421
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069
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Country | US
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Telephone | 310-597-9786
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. SHAHRAM TABIB
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Credential | MD
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Telephone | 310-597-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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