Provider Demographics
NPI:1558558023
Name:NABIL K ABUDAYEH MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NABIL K ABUDAYEH MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABUDAYEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-886-6878
Mailing Address - Street 1:20700 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5401
Mailing Address - Country:US
Mailing Address - Phone:510-886-6878
Mailing Address - Fax:510-886-0268
Practice Address - Street 1:20700 LAKE CHABOT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5401
Practice Address - Country:US
Practice Address - Phone:510-886-6878
Practice Address - Fax:510-886-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699724484OtherTYPE 1 NPI
1699724484OtherNPPES
CA110245276OtherRAILROAD MEDICARE
CA00G590720Medicaid
CA00G590720Medicaid
CA00G590722Medicare PIN
CAF03946Medicare UPIN