Provider Demographics
NPI:1558809277
Name:SOUTHERN CALIFORNIA HEPATOBILIARY PANCREATIC AND ROBOTIC SURGERY INS
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEPATOBILIARY PANCREATIC AND ROBOTIC SURGERY INS
Other - Org Name:BABAK EGHBALIEH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECTIVE OFFICER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHBALIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-488-5188
Mailing Address - Street 1:458 N LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 690
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411
Practice Address - Country:US
Practice Address - Phone:818-900-6480
Practice Address - Fax:818-900-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89592208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty