Provider Demographics
NPI:1235195405
Name:TABAK, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:TABAK
Suffix:
Gender:M
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:LASER SKIN CARE CENTER
Mailing Address - Street 2:3918 LONG BEACH BOULEVARD SUITE 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2615
Mailing Address - Country:US
Mailing Address - Phone:562-989-7829
Mailing Address - Fax:562-989-3612
Practice Address - Street 1:LASER SKIN CARE CENTER
Practice Address - Street 2:3918 LONG BEACH BOULEVARD SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2615
Practice Address - Country:US
Practice Address - Phone:562-989-7829
Practice Address - Fax:562-989-3612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist