Provider Demographics
NPI:1770774770
Name:EGHBALIEH, BABAK (MD FACS)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:EGHBALIEH
Suffix:
Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:5805 SEPULVEDA BLVD STE 690
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2522
Mailing Address - Country:US
Mailing Address - Phone:818-900-6480
Mailing Address - Fax:818-900-6488
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 690
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2522
Practice Address - Country:US
Practice Address - Phone:818-900-6480
Practice Address - Fax:818-900-6489
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA895922086X0206X, 208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89592Medicare PIN