Healthcare Provider Details

I. General information

NPI: 1558620047
Provider Name (Legal Business Name): MULUNEH ABEBE YIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MULUNEH ABEBE M.D.

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 K STREET SUITE 200
SACRAMENTO CA
95816-5122
US

IV. Provider business mailing address

2929 K STREET SUITE 200
SACRAMENTO CA
95816-5122
US

V. Phone/Fax

Practice location:
  • Phone: 916-750-2328
  • Fax: 916-710-8113
Mailing address:
  • Phone: 916-750-2328
  • Fax: 916-710-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number155887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA155887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: