Provider Demographics
NPI:1740274547
Name:ABDULLAH, EDWARD EZRA (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:EZRA
Last Name:ABDULLAH
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 1:1245 WILSHIRE BLVD STE 580
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5854
Mailing Address - Country:US
Mailing Address - Phone:213-977-0419
Mailing Address - Fax:213-977-0225
Practice Address - Street 1:1245 WILSHIRE BLVD STE 580
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5854
Practice Address - Country:US
Practice Address - Phone:213-977-0419
Practice Address - Fax:213-977-0225
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59365207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G593650Medicaid
CAP00128330OtherMEDICARE RAILROAD
CAP00128330OtherMEDICARE RAILROAD
CA00G593650Medicaid
CA006593650Medicare PIN