Provider Demographics
NPI:1891724316
Name:ABED, JOHN ABDELSHEHID
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ABDELSHEHID
Last Name:ABED
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ABDELSHEHID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 661987
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1987
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:3865 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3919
Practice Address - Country:US
Practice Address - Phone:310-200-7199
Practice Address - Fax:909-944-1608
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81545207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A815450Medicaid
CA00A815450Medicaid
CAI10068Medicare UPIN
CA00A815453Medicare PIN