MEDICARE: DR. BEHNAM SAM 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	174400000X	Specialist	A61974	CA

General Provider Information

NPI Number	:	1710955539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEHNAM SAM TABIBIAN M.D.

Provider Business Mailing Address
First Line	:	11693 SAN VICENTE BLVD
Second Line	:	SUITE 523
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5105
Country	:	US
Telephone Number	:	818-905-3355
Fax Number	:	818-905-0044

Provider Business Practice Location Address
First Line	:	14925 BURBANK BLVD.
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-2110
Country	:	US
Telephone Number	:	818-905-3355
Fax Number	:	818-905-0044

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	01/12/2023

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