Basic Information
| Provider Information | |||||||||
| NPI: | 1619906963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARGAN | ||||||||
| FirstName: | STEPHAN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 512717 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900510717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104234100 | ||||||||
| FaxNumber: | 3104230146 | ||||||||
| Practice Location | |||||||||
| Address1: | 8700 BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900481804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104234100 | ||||||||
| FaxNumber: | 3104230146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G22752 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | G22752 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RG0100X | G22752 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.