Provider Demographics
NPI:1427114032
Name:PARHAM TABIBIAN MD INC
Entity type:Organization
Organization Name:PARHAM TABIBIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-738-6006
Mailing Address - Street 1:2733 AQUA VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1502
Mailing Address - Country:US
Mailing Address - Phone:310-738-6006
Mailing Address - Fax:818-706-3744
Practice Address - Street 1:3851 KATELLA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3309
Practice Address - Country:US
Practice Address - Phone:562-799-3330
Practice Address - Fax:562-799-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20560OtherMEDICARE ID