Provider Demographics
NPI:1306923016
Name:BABU-KHAN, NASREEN (MD)
Entity type:Individual
Prefix:
First Name:NASREEN
Middle Name:
Last Name:BABU-KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MONUMENT ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3800
Mailing Address - Country:US
Mailing Address - Phone:310-454-5915
Mailing Address - Fax:310-454-5027
Practice Address - Street 1:970 MONUMENT ST
Practice Address - Street 2:SUITE 114
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3800
Practice Address - Country:US
Practice Address - Phone:310-454-5915
Practice Address - Fax:310-454-5027
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75944207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75944OtherLICENSE #
CA95-4698937OtherTAX ID #
CA95-4698937OtherTAX ID #
CAG75944OtherLICENSE #