Individual provider Active NPI

Tahany Maurice Habashy, MD

  • Family Medicine Physician
  • Tustin, CA
National Provider Identifier
1619064953
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A65338 Issued in CA
Practice address
222 West Main St
Suite 102
Tustin, CA 92780-7711
Phone
(714) 730-0060
Fax
(714) 730-0061
NPI assigned
Oct 6, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A65338 CA Primary

Addresses

Primary practice location

222 West Main St
Suite 102
Tustin, CA 92780-7711

Mailing address

222 West Main St
Suite 102
Tustin, CA 92780-7711
Phone (714) 730-0060

Other identifiers 1

IdentifierTypeStateIssuer
00A653380MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
65338CAMDPharmacist
A65338CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Family Medicine Past Accepting new patients
Ucr Health - Psychiatry PastSince Jun 12, 2022 Accepting new patients
Regents of the University of California Family Medicine PastSince Jun 12, 2022 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1619064953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WEST MAIN ST",
            "address_2": "SUITE 102",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807711",
            "telephone_number": "714-730-0060",
            "fax_number": "714-730-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WEST MAIN ST",
            "address_2": "SUITE 102",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807711",
            "telephone_number": "714-730-0060",
            "fax_number": "714-730-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABASHY",
        "first_name": "TAHANY",
        "middle_name": "MAURICE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A65338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A653380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.