Provider Demographics
NPI:1659424943
Name:TZADIK, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:TZADIK
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 1:1304 15TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1813
Mailing Address - Country:US
Mailing Address - Phone:310-305-1020
Mailing Address - Fax:310-823-4785
Practice Address - Street 1:1304 15TH ST STE 405
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1813
Practice Address - Country:US
Practice Address - Phone:310-305-1020
Practice Address - Fax:310-823-4785
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50503Medicare ID - Type Unspecified
CAB50503Medicare UPIN