Provider Demographics
NPI:1366470338
Name:TABIBIAN, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:TABIBIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PARHAM
Other - Middle Name:M
Other - Last Name:TABIBIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2733 AQUA VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1502
Mailing Address - Country:US
Mailing Address - Phone:310-738-6006
Mailing Address - Fax:818-706-8822
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:STE 430
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-799-3330
Practice Address - Fax:562-799-3399
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80532207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG80532FMedicare PIN