Provider Demographics
NPI:1497864573
Name:KINAWY, GHADIR M (MD)
Entity Type:Individual
Prefix:DR
First Name:GHADIR
Middle Name:M
Last Name:KINAWY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SOUTH ORANGE HILL LANE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3713
Mailing Address - Country:US
Mailing Address - Phone:714-547-9090
Mailing Address - Fax:714-547-5005
Practice Address - Street 1:1125 E 17TH STREET
Practice Address - Street 2:SUITE W112
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2213
Practice Address - Country:US
Practice Address - Phone:714-547-9090
Practice Address - Fax:714-547-5005
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64905208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649050Medicaid
H61057Medicare UPIN
A64905Medicare ID - Type Unspecified