Provider Demographics
NPI:1134916745
Name:TABATABAI ASL, DARYUSH KEVIN (PHARMD)
Entity type:Individual
Prefix:
First Name:DARYUSH
Middle Name:KEVIN
Last Name:TABATABAI ASL
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:DARYUSH
Other - Middle Name:KEVIN
Other - Last Name:TABATABAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4481 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4707
Mailing Address - Country:US
Mailing Address - Phone:619-206-4912
Mailing Address - Fax:
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:619-206-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA767841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy