Healthcare Provider Details

I. General information

NPI: 1689628687
Provider Name (Legal Business Name): STEPHEN ISRAEL ABEDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SULLIVAN AVE
DALY CITY CA
94015-2200
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 650-691-6503
  • Fax: 650-991-6755
Mailing address:
  • Phone: 415-884-3418
  • Fax: 415-883-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG70312
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG70312
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01091119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: