Provider Demographics
NPI:1376585042
Name:ABUDU, ASSIBI Z (MD)
Entity Type:Individual
Prefix:DR
First Name:ASSIBI
Middle Name:Z
Last Name:ABUDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662046
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-2046
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1701 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3482
Practice Address - Country:US
Practice Address - Phone:626-350-7957
Practice Address - Fax:626-448-0485
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32689207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G326890Medicaid
CAWG32689PMedicare PIN
CAWG32689QMedicare PIN
CAWG32689Medicare PIN
CAB53505Medicare UPIN