Provider Demographics
NPI:1053438622
Name:RABBANI, KAMRAN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:CHRISTOPHER
Last Name:RABBANI
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 1:5363 BALBOA BLVD
Mailing Address - Street 2:542
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-788-9200
Mailing Address - Fax:818-788-9621
Practice Address - Street 1:5363 BALBOA BLVD
Practice Address - Street 2:542
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-788-9200
Practice Address - Fax:818-788-9621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM143ZMedicare PIN
CAA70167Medicare ID - Type Unspecified
CA00A701670Medicaid