Provider Demographics
NPI:1932368347
Name:TAHANY MAURICE HABASHY M.D. INC
Entity Type:Organization
Organization Name:TAHANY MAURICE HABASHY M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAHANY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-730-0060
Mailing Address - Street 1:222 W MAIN ST
Mailing Address - Street 2:#102
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7720
Mailing Address - Country:US
Mailing Address - Phone:714-730-0060
Mailing Address - Fax:714-730-0061
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:#102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7720
Practice Address - Country:US
Practice Address - Phone:714-730-0060
Practice Address - Fax:714-730-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A653380Medicaid
CA00A653380Medicaid
CAG85122Medicare UPIN