MEDICARE: IMAN ABDEL BAR MD INC

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	208000000X	Pediatrics Physician	A72354	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	:	1932620812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAN ABDEL BAR MD INC

Provider Business Mailing Address
First Line	:	2077 HARBOR BLVD UNIT A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2630
Country	:	US
Telephone Number	:	949-675-6759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2077 HARBOR BLVD UNIT A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2630
Country	:	US
Telephone Number	:	949-675-6759
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. IMAN ABDEL BAR
Credential	:	A72354
Telephone Number	:	949-675-6759

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	07/21/2022

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