MEDICARE: BIALICK TABIBIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A47826	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043323421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIALICK TABIBIAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25427
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-0427
Country	:	US
Telephone Number	:	310-914-9150
Fax Number	:	310-914-9705

Provider Business Practice Location Address
First Line	:	8540 S SEPULVEDA BLVD STE 1100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3819
Country	:	US
Telephone Number	:	310-914-9150
Fax Number	:	310-914-9705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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