1285954941 NPI number — KANDAN BABAN D.O.

Table of content: KANDAN BABAN D.O. (NPI 1285954941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285954941 NPI number — KANDAN BABAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABAN
Provider First Name:
KANDAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285954941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 S JUNIPER ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-4941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-228-2236
Provider Business Mailing Address Fax Number:
760-737-3430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-291-6861
Provider Business Practice Location Address Fax Number:
760-291-6862
Provider Enumeration Date:
06/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  20A10598 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X , with the licence number: 20A10598 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 20A10598 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)