Provider Demographics
NPI:1467488809
Name:ZAHRA TABASSIAN MD INC
Entity Type:Organization
Organization Name:ZAHRA TABASSIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-671-2420
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:310-350-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15280Medicare ID - Type UnspecifiedGROUP PROVIDER