Provider Demographics
NPI:1184714453
Name:SABETIAN, KATAYOUN (MD)
Entity type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:SABETIAN
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 1:2323 16TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3453
Mailing Address - Country:US
Mailing Address - Phone:661-322-4601
Mailing Address - Fax:
Practice Address - Street 1:2323 16TH ST STE 206
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3453
Practice Address - Country:US
Practice Address - Phone:661-322-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG074923204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749230Medicaid
CA770434389OtherTAX ID
CA770434389OtherTAX ID
CA00G749230Medicare ID - Type Unspecified