Basic Information
Provider Information
NPI: 1285748525
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SABAHI
FirstName: HOUMAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5329
Address2:  
City: SAGINAW
State: MI
PostalCode: 486030329
CountryCode: US
TelephoneNumber: 5033437128
FaxNumber: 5033437129
Practice Location
Address1: 2111 EXCHANGE ST
Address2: DEPT OF RADIOLOGY
City: ASTORIA
State: OR
PostalCode: 971033329
CountryCode: US
TelephoneNumber: 5033387525
FaxNumber: 5033251765
Other Information
ProviderEnumerationDate: 08/17/2006
LastUpdateDate: 06/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD00034151WAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XMD19977ORY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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