Provider Demographics
NPI:1548563067
Name:RYAN TABAN, M.D., INC.
Entity Type:Organization
Organization Name:RYAN TABAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-3937
Mailing Address - Street 1:2080 CENTURY PARK E STE 1202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2015
Mailing Address - Country:US
Mailing Address - Phone:310-556-3937
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:310-556-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99816207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty