Provider Demographics
NPI:1972553576
Name:ABRISHAMI, BABAK B (DO)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:B
Last Name:ABRISHAMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
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:323-913-9140
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 902
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-913-9130
Practice Address - Fax:323-913-9140
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7450207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7450OtherSTATE LICENSE