Provider Demographics
NPI:1124223433
Name:TABAN, MEHRYAR RAY (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MEHRYAR
Middle Name:RAY
Last Name:TABAN
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:TABAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:9735 WILSHIRE BLVD
Mailing Address - Street 2:STE 319
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2111
Mailing Address - Country:US
Mailing Address - Phone:310-278-1836
Mailing Address - Fax:310-278-1828
Practice Address - Street 1:9735 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-278-1836
Practice Address - Fax:310-278-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99093207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A990930Medicaid
CAWA99093AMedicare PIN