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NPI Code Detail

MEDICARE: DR. BRIAN TABAK M.D.

MEDICARE: DR. BRIAN TABAK 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
1174400000XSpecialistG37068CA

General Provider Information

NPI Number : 1235195405
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN TABAK M.D.
Provider Business Mailing Address
First Line : LASER SKIN CARE CENTER
Second Line : 3918 LONG BEACH BOULEVARD SUITE 200
City : LONG BEACH
State : CA
Zip : 90807-2615
Country : US
Telephone Number : 562-989-7829
Fax Number : 562-989-3612
Provider Business Practice Location Address
First Line : LASER SKIN CARE CENTER
Second Line : 3918 LONG BEACH BOULEVARD SUITE 200
City : LONG BEACH
State : CA
Zip : 90807-2615
Country : US
Telephone Number : 562-989-7829
Fax Number : 562-989-3612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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