Basic Information
| Provider Information | |||||||||
| NPI: | 1700878410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDEEN | ||||||||
| FirstName: | OMARAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11550 INDIAN HILLS RD | ||||||||
| Address2: | SUITE 371 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183651194 | ||||||||
| FaxNumber: | 8188983835 | ||||||||
| Practice Location | |||||||||
| Address1: | 11550 INDIAN HILLS RD | ||||||||
| Address2: | SUITE 371 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183651194 | ||||||||
| FaxNumber: | 8188983835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A55592 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | A55592 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A555920 | 05 | CA | MEDICAID |