Provider Demographics
NPI:1497892699
Name:ABRISHAMI, BABAK
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:ABRISHAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 KIOWA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6135
Mailing Address - Country:US
Mailing Address - Phone:310-435-5537
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 508
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:747-245-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43515OtherDENTICAL PROVIDER NUMBER
CAG91571-01OtherDENTICAL OFFICE NUMBER