Provider Demographics
NPI:1962441691
Name:TABIBIAN, SEPIDEH (MD)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:TABIBIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 CANOGA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6568
Mailing Address - Country:US
Mailing Address - Phone:818-595-8100
Mailing Address - Fax:818-595-8206
Practice Address - Street 1:5700 CANOGA AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6568
Practice Address - Country:US
Practice Address - Phone:818-595-8100
Practice Address - Fax:818-595-8206
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI29967Medicare UPIN