Provider Demographics
NPI:1932620812
Name:IMAN ABDEL BAR MD INC
Entity type:Organization
Organization Name:IMAN ABDEL BAR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:ABDEL
Authorized Official - Last Name:BAR
Authorized Official - Suffix:
Authorized Official - Credentials:A72354
Authorized Official - Phone:949-675-6759
Mailing Address - Street 1:2077 HARBOR BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2630
Mailing Address - Country:US
Mailing Address - Phone:949-675-6759
Mailing Address - Fax:
Practice Address - Street 1:2077 HARBOR BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2630
Practice Address - Country:US
Practice Address - Phone:949-675-6759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326127804Medicaid