Provider Demographics
NPI:1609343771
Name:PARHAM TABIBIAN MD INC
Entity type:Organization
Organization Name:PARHAM TABIBIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TABIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-738-6006
Mailing Address - Street 1:3851 KATELLA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3389
Mailing Address - Country:US
Mailing Address - Phone:562-799-3330
Mailing Address - Fax:
Practice Address - Street 1:30300 AGOURA RD STE 200
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5413
Practice Address - Country:US
Practice Address - Phone:818-706-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARHAM TABIBIAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222113OtherPTAN