=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306074497
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL ASHLEY ALBIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 WEST BELLEVUE DRIVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-584-6116
-----------------------------------------------------
Fax | 626-584-7886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 WEST BELLEVUE DRIVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-584-6116
-----------------------------------------------------
Fax | 626-584-7886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A130605
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------