MEDICARE: DR. BABAK OURIAN 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	208D00000X	General Practice Physician	A60929	CA

General Provider Information

NPI Number	:	1790788560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABAK OURIAN M.D.

Provider Business Mailing Address
First Line	:	9025 WILSHIRE BLVD 405
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1828
Country	:	US
Telephone Number	:	310-859-2704
Fax Number	:	310-859-2709

Provider Business Practice Location Address
First Line	:	9025 WILSHIRE BLVD
Second Line	:	STE 207
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1825
Country	:	US
Telephone Number	:	310-859-2704
Fax Number	:	310-859-2709

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/05/2015

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