Provider Demographics
NPI:1801884093
Name:SADIK, SHAHIN ABRAHAM (MD, QME)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:ABRAHAM
Last Name:SADIK
Suffix:
Gender:M
Credentials:MD, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 AUTO CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-267-6876
Mailing Address - Fax:661-538-9483
Practice Address - Street 1:819 AUTO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-267-6876
Practice Address - Fax:661-538-9483
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50928Medicare UPIN
G72668DMedicare ID - Type Unspecified