Provider Demographics
NPI:1790775278
Name:ABBAS, MAZEN ISSAM (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:ISSAM
Last Name:ABBAS
Suffix:
Gender:M
Credentials:DO, MPH
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Mailing Address - Street 1:1015 AOLOA PL APT 259
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5212
Mailing Address - Country:US
Mailing Address - Phone:808-726-6653
Mailing Address - Fax:808-378-7075
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # SE09
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-5745
Practice Address - Fax:559-353-6093
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A14673208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790775278Medicaid