Healthcare Provider Details

I. General information

NPI: 1760776728
Provider Name (Legal Business Name): JEAN-PAUL ABBOUD M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11199 SORRENTO VALLEY RD STE 202
SAN DIEGO CA
92121-1334
US

IV. Provider business mailing address

11199 SORRENTO VALLEY RD STE 202
SAN DIEGO CA
92121-1334
US

V. Phone/Fax

Practice location:
  • Phone: 858-356-2647
  • Fax:
Mailing address:
  • Phone: 858-356-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberA124875
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA124875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: