Healthcare Provider Details

I. General information

NPI: 1841242948
Provider Name (Legal Business Name): ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 200
LOS ANGELES CA
90036
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD STE 136
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 323-954-1788
  • Fax: 323-954-1822
Mailing address:
  • Phone: 323-553-7308
  • Fax: 323-556-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG71854
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG71854
License Number StateCA

VIII. Authorized Official

Name: ABRAHAM M ISHAAYA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-954-1788