Provider Demographics
NPI:1326127804
Name:BAR, IMAN ABDEL (MD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:ABDEL
Last Name:BAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IMAN
Other - Middle Name:
Other - Last Name:BAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2077 HARBOR BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2630
Mailing Address - Country:US
Mailing Address - Phone:949-646-3623
Mailing Address - Fax:
Practice Address - Street 1:2077 HARBOR BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2630
Practice Address - Country:US
Practice Address - Phone:949-646-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72354208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A723540Medicaid