Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 4301091303 | MI |
N | 208200000X | Surgeon | 4301091303 | MI |
N | 208600000X | Surgeon | 4301091303 | MI |
Y | 208200000X | Surgeon | A152200 | CA |
Y | 208600000X | Surgeon | A152200 | CA |
NPI | 1790946895 |
---|---|
Provider Name | Dr. Ahmad Abou Abbass |
First Address | Mission Viejo, CA 92691-6374 |
Second Address | Mission Viejo, CA 92691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 10/08/2018 |