Provider Demographics
NPI:1316678162
Name:KATAYOUN ABTIN DPM A PROFESSIONAL CORP
Entity type:Organization
Organization Name:KATAYOUN ABTIN DPM A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-739-7797
Mailing Address - Street 1:1726 S BENTLEY AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1726 S BENTLEY AVE APT 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4343
Practice Address - Country:US
Practice Address - Phone:818-414-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty