=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295955763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMRAN C. RABBANI, MD A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5363 BALBOA BLVD SUITE 542
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-9200
-----------------------------------------------------
Fax | 818-788-9621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5363 BALBOA BLVD SUITE 542
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAMRAN C RABBANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-788-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A70167
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------