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General NPI Number Information
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NPI Number | 1730596040
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Entity Type | Individual
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Provider Name | GHASSAN KABBACH M.D
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Gender | Male
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 27700 MEDICAL CENTER RD
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6426
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Country | US
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Telephone | 949-365-2468
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Fax | 949-365-3896
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Provider Business Mailing Address
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Address Line | 200 W CENTER STREET PROMENADE
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City | ANAHEIM
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State | CA
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Zip | 92805-3960
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Country | US
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Telephone | 805-456-6349
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53863
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2022-1193
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C193091
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License Number State | CA
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