Provider Demographics
NPI:1871521716
Name:TABASSIAN, ZAHRA (MD)
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:TABASSIAN
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:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-0661
Mailing Address - Country:US
Mailing Address - Phone:310-671-2420
Mailing Address - Fax:310-330-5670
Practice Address - Street 1:994 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3816
Practice Address - Country:US
Practice Address - Phone:310-671-2420
Practice Address - Fax:310-330-5670
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47974207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12275Medicare UPIN