Provider Demographics
NPI:1205207628
Name:KAYALI CONSULTING AND MEDICAL MANAGEMENT INC
Entity Type:Organization
Organization Name:KAYALI CONSULTING AND MEDICAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZEID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-517-3501
Mailing Address - Street 1:2006 W RIVERSIDE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377
Mailing Address - Country:US
Mailing Address - Phone:909-883-2999
Mailing Address - Fax:
Practice Address - Street 1:2006 N RIVERSIDE AVE
Practice Address - Street 2:STE A
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4696
Practice Address - Country:US
Practice Address - Phone:909-883-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71164207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB249824OtherMEDICARE PTAN