Provider Demographics
NPI:1366468555
Name:SABET, ABDOLLAH A (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDOLLAH
Middle Name:A
Last Name:SABET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1209 W TOKAY STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240
Mailing Address - Country:US
Mailing Address - Phone:209-331-2070
Mailing Address - Fax:209-331-2077
Practice Address - Street 1:1209 W TOKAY STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:765-983-8000
Practice Address - Fax:765-983-8609
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC534012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200358280Medicaid
INA09729Medicare UPIN
INA09729Medicare UPIN