Provider Demographics
NPI:1922570589
Name:DANIEL AHOUBIM, MD PC
Entity Type:Organization
Organization Name:DANIEL AHOUBIM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHOUBIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-334-5810
Mailing Address - Street 1:PO BOX 25082
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0082
Mailing Address - Country:US
Mailing Address - Phone:646-334-5810
Mailing Address - Fax:818-877-7716
Practice Address - Street 1:18370 BURBANK BLVD STE 414
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-877-7715
Practice Address - Fax:818-877-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA144380OtherLICENSE