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General NPI Number Information
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NPI Number | 1548563067
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Entity Type | Organization
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Legal Business Name | RYAN TABAN, M.D., INC.
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 1202
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City | LOS ANGELES
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State | CA
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Zip | 90067-2015
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Country | US
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Telephone | 310-556-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E STE 1202
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City | LOS ANGELES
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State | CA
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Zip | 90067-2015
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Country | US
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Telephone | 310-556-3937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN TABAN
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Credential | M.D.
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Telephone | 310-556-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A99816
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License Number State | CA
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