Provider Demographics
NPI:1801871819
Name:KABBINAVAR, FAIROOZ (MD)
Entity type:Individual
Prefix:DR
First Name:FAIROOZ
Middle Name:
Last Name:KABBINAVAR
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10945 LE CONTE AVE
Mailing Address - Street 2:SUITE # 2338 J / PVUB 957187
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3000
Mailing Address - Country:US
Mailing Address - Phone:310-206-3921
Mailing Address - Fax:310-267-0151
Practice Address - Street 1:10945 LE CONTE AVE
Practice Address - Street 2:SUITE # 2338 J / PVUB 957187
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3000
Practice Address - Country:US
Practice Address - Phone:310-206-3921
Practice Address - Fax:310-267-0151
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 45968207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A459680Medicaid
CAWA45968BMedicare PIN
E 41219Medicare UPIN