Provider Demographics
NPI:1043638885
Name:ABRAHAM, JAEON (MD)
Entity type:Individual
Prefix:DR
First Name:JAEON
Middle Name:
Last Name:ABRAHAM
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 1:3105 W 15TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7700
Mailing Address - Country:US
Mailing Address - Phone:972-867-2869
Mailing Address - Fax:972-964-5219
Practice Address - Street 1:3105 W 15TH ST STE D
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7700
Practice Address - Country:US
Practice Address - Phone:972-867-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics