Healthcare Provider Details

I. General information

NPI: 1881180784
Provider Name (Legal Business Name): ANAS NABIL ABU-KHADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

134 S WESTERN AVE APT 6
ANAHEIM CA
92804-1672
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC205981
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0024012
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0102948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: