Provider Demographics
NPI:1396961538
Name:ABDEL-KERIM, ASHRAF I
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:I
Last Name:ABDEL-KERIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ASHRAF
Other - Middle Name:IBRAHIM
Other - Last Name:ABDELKERIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60038
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-6038
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:5451 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2609
Practice Address - Country:US
Practice Address - Phone:909-464-8666
Practice Address - Fax:909-464-8913
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A942280Medicaid
CAWA94228AMedicare PIN
CA00A942280Medicare PIN