Provider Demographics
NPI:1922762806
Name:VITAL LUNGS ASSOCIATES OF SOUTHERN CALIFORNIA INC
Entity Type:Organization
Organization Name:VITAL LUNGS ASSOCIATES OF SOUTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATABAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-375-6431
Mailing Address - Street 1:22543 VENTURA BLVD UNIT 220-117
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1412
Mailing Address - Country:US
Mailing Address - Phone:626-375-6431
Mailing Address - Fax:
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty