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General NPI Number Information
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NPI Number | 1629003264
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Entity Type | Individual
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Provider Name | BABAK MOEINOLMOLKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 1215 BROCKTON AVE STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1372
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Country | US
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Telephone | 310-694-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E SUITE 1508
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City | LOS ANGELES
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State | CA
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Zip | 90067-2001
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Country | US
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Telephone | 310-694-4486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D63791
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A92803
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 29841
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD034439
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 233310
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License Number State | NY
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