Provider Demographics
NPI:1750311791
Name:BABAK ROOZROKH, MD INC
Entity Type:Organization
Organization Name:BABAK ROOZROKH, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOZROKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-475-4865
Mailing Address - Street 1:1700 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5608
Mailing Address - Country:US
Mailing Address - Phone:800-941-4161
Mailing Address - Fax:310-234-6604
Practice Address - Street 1:1700 WESTWOOD BLVD
Practice Address - Street 2:SUITE 2D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5608
Practice Address - Country:US
Practice Address - Phone:800-941-4161
Practice Address - Fax:310-234-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A816460Medicaid
CA00A816460Medicaid