Provider Demographics
NPI:1841242948
Name:ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ABRAHAM ISHAAYA, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISHAAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-954-1788
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:STE 136
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:323-553-7308
Mailing Address - Fax:323-556-7350
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-954-1788
Practice Address - Fax:323-954-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71854207RA0201X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G718541Medicaid
CA00G718541Medicaid