Provider Demographics
NPI:1548227796
Name:TASHAKKOR, BABAK (MD)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:TASHAKKOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3954
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:626-793-3794
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 500
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-793-1227
Practice Address - Fax:626-793-3794
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63829207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00068796OtherMEDICARE RAIL ROAD
CAA063829OtherBLUE SHIELD
CAWA63829CMedicare ID - Type Unspecified
CAA063829OtherBLUE SHIELD