Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | C37937 | CA |
NPI | 1215968474 |
---|---|
Provider Name | Khalil M Tabsh |
First Address | Los Angeles, CA 90095 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 13/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C379370 | (05) | CA |
A36798 | (02) | CA |