1841242948 NPI number — ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION

Table of content: (NPI 1841242948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841242948 NPI number — ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841242948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
STE 136
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-553-7308
Provider Business Mailing Address Fax Number:
323-556-7350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 W OLYMPIC BLVD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-954-1788
Provider Business Practice Location Address Fax Number:
323-954-1822
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISHAAYA
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
323-954-1788

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X , with the licence number:  G71854 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: G71854 , 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)

  • Identifier: 00G718541 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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