Provider Demographics
NPI:1912959925
Name:ISHAAYA, ABRAHAM M (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:M
Last Name:ISHAAYA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:STE 136
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:323-553-7308
Mailing Address - Fax:323-556-7350
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4663
Practice Address - Country:US
Practice Address - Phone:323-954-1788
Practice Address - Fax:323-954-1822
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG71854207RA0201X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G718541Medicaid
CA00G718541Medicaid