Provider Demographics
NPI:1508128505
Name:ISRAEL, ABBAYAEL KANI-BEN
Entity Type:Individual
Prefix:
First Name:ABBAYAEL
Middle Name:KANI-BEN
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6033
Mailing Address - Country:US
Mailing Address - Phone:405-210-4182
Mailing Address - Fax:
Practice Address - Street 1:5909 NW EXPRESSWAY STE 232
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-4476
Practice Address - Country:US
Practice Address - Phone:405-931-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)