Provider Demographics
NPI:1508386442
Name:ABDOLI, SHERWIN (MD)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:ABDOLI
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 1:612 W DUARTE RD STE 804
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9250
Mailing Address - Country:US
Mailing Address - Phone:626-600-2094
Mailing Address - Fax:626-226-5827
Practice Address - Street 1:612 W DUARTE RD STE 804
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9250
Practice Address - Country:US
Practice Address - Phone:626-600-2094
Practice Address - Fax:626-226-5827
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156958208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery