Provider Demographics
NPI:1790815082
Name:LOS ANGELES LUNG CENTER - A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LOS ANGELES LUNG CENTER - A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:BOB
Authorized Official - Last Name:ABRISHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-913-9130
Mailing Address - Street 1:PO BOX 480481
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1481
Mailing Address - Country:US
Mailing Address - Phone:323-913-9130
Mailing Address - Fax:213-977-0656
Practice Address - Street 1:1300 N VERMONT AVE STE 902
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6094
Practice Address - Country:US
Practice Address - Phone:323-913-9130
Practice Address - Fax:323-913-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7450207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty