Basic Information
| Provider Information | |||||||||
| NPI: | 1366468555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABET | ||||||||
| FirstName: | ABDOLLAH | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1209 W TOKAY STREET | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093312070 | ||||||||
| FaxNumber: | 2093312077 | ||||||||
| Practice Location | |||||||||
| Address1: | 1209 W TOKAY STREET | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659838000 | ||||||||
| FaxNumber: | 7659838609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | C53401 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 200358280 | 05 | IN | MEDICAID |