Provider Demographics
NPI:1205880994
Name:HEPNER, ABSALOM D (MD)
Entity type:Individual
Prefix:
First Name:ABSALOM
Middle Name:D
Last Name:HEPNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8038
Mailing Address - Country:US
Mailing Address - Phone:949-364-3570
Mailing Address - Fax:949-364-3430
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8038
Practice Address - Country:US
Practice Address - Phone:949-364-3570
Practice Address - Fax:949-364-3430
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78126207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A781260Medicaid
CA00A781260Medicaid
CAWA78126CMedicare PIN
CAGW290ZMedicare PIN