Provider Demographics
NPI:1578345625
Name:GOLDEN STATE FAMILY CLINIC
Entity Type:Organization
Organization Name:GOLDEN STATE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-720-0731
Mailing Address - Street 1:PO BOX 18025
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8025
Mailing Address - Country:US
Mailing Address - Phone:941-720-0731
Mailing Address - Fax:
Practice Address - Street 1:4082 WHITTIER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2559
Practice Address - Country:US
Practice Address - Phone:323-347-5757
Practice Address - Fax:323-264-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty