Provider Demographics
NPI:1891332805
Name:PARICHEHR TABIBIAN, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PARICHEHR TABIBIAN, MD, A PROFESSIONAL CORPORATION
Other - Org Name:BLUE LOTUS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PARICHEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-481-1417
Mailing Address - Street 1:4959 DOMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4311
Mailing Address - Country:US
Mailing Address - Phone:818-481-1417
Mailing Address - Fax:505-210-7275
Practice Address - Street 1:20315 VENTURA BLVD STE 315A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2449
Practice Address - Country:US
Practice Address - Phone:818-481-1417
Practice Address - Fax:505-210-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty