Provider Demographics
NPI:1295955763
Name:KAMRAN C. RABBANI, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KAMRAN C. RABBANI, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-9200
Mailing Address - Street 1:5363 BALBOA BLVD
Mailing Address - Street 2:SUITE 542
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2853
Mailing Address - Country:US
Mailing Address - Phone:818-788-9200
Mailing Address - Fax:
Practice Address - Street 1:5363 BALBOA BLVD
Practice Address - Street 2:SUITE 542
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2853
Practice Address - Country:US
Practice Address - Phone:818-788-9200
Practice Address - Fax:818-788-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM129AMedicare PIN
CA00A701670Medicaid