Provider Demographics
NPI:1740245265
Name:TEBYANI, NEYSSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEYSSAN
Middle Name:
Last Name:TEBYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 LA PAZ RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5110
Mailing Address - Country:US
Mailing Address - Phone:949-215-9516
Mailing Address - Fax:949-215-9517
Practice Address - Street 1:25200 LA PAZ RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5110
Practice Address - Country:US
Practice Address - Phone:949-855-1101
Practice Address - Fax:949-855-8710
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA62271DMedicare ID - Type Unspecified
CAH69204Medicare UPIN
CAWA62271CMedicare ID - Type Unspecified