Provider Demographics
NPI:1154455178
Name:ABBASS, KHURRAM (MD)
Entity Type:Individual
Prefix:
First Name:KHURRAM
Middle Name:
Last Name:ABBASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 480
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1595
Mailing Address - Country:US
Mailing Address - Phone:408-684-4104
Mailing Address - Fax:669-263-6050
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 480
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1595
Practice Address - Country:US
Practice Address - Phone:408-684-4104
Practice Address - Fax:669-263-6050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093406207R00000X
IN01063328A207R00000X
CAA129410207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3118969Medicaid
OH3118969Medicaid
CACA122650Medicare PIN
OHH327490Medicare PIN