Healthcare Provider Details

I. General information

NPI: 1518434281
Provider Name (Legal Business Name): KAZEEM ABASS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 BAUCHET ST
LOS ANGELES CA
90012-2906
US

IV. Provider business mailing address

38127 MENDOCINO WAY
PALMDALE CA
93550-6550
US

V. Phone/Fax

Practice location:
  • Phone: 213-974-4961
  • Fax:
Mailing address:
  • Phone: 818-626-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: