Healthcare Provider Details

I. General information

NPI: 1700878410
Provider Name (Legal Business Name): OMARAN A ABDEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD SUITE 371
MISSION HILLS CA
91345-1200
US

IV. Provider business mailing address

11550 INDIAN HILLS RD SUITE 371
MISSION HILLS CA
91345-1200
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-1194
  • Fax: 818-898-3835
Mailing address:
  • Phone: 818-365-1194
  • Fax: 818-898-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA55592
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA55592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: