Healthcare Provider Details

I. General information

NPI: 1114903762
Provider Name (Legal Business Name): ABRAHAM PAYKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W AVENUE J SUITE 203
LANCASTER CA
93534-2824
US

IV. Provider business mailing address

1601 W AVENUE J SUITE 203
LANCASTER CA
93534-2824
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-3131
  • Fax: 661-723-3112
Mailing address:
  • Phone: 661-723-3131
  • Fax: 661-723-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA54392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: