1518583301 NPI number — DR. CALEB ABEKU ARTHUR MD

Table of content: CLARA YU (NPI 1962169193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518583301 NPI number — DR. CALEB ABEKU ARTHUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTHUR
Provider First Name:
CALEB
Provider Middle Name:
ABEKU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518583301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 PULLMAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94607-1586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-558-2226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 PINOLE VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINOLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94564-1384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-243-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  4351046026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A191280 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)