Provider Demographics
NPI:1750651543
Name:NASREEN BABU-KHAN MD A PROF CORP
Entity Type:Organization
Organization Name:NASREEN BABU-KHAN MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU-KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-454-5915
Mailing Address - Street 1:970 MONUMENT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3874
Mailing Address - Country:US
Mailing Address - Phone:310-454-5915
Mailing Address - Fax:310-454-5027
Practice Address - Street 1:970 MONUMENT ST STE 114
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3874
Practice Address - Country:US
Practice Address - Phone:310-454-5915
Practice Address - Fax:310-454-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty