Provider Demographics
NPI:1801864301
Name:HADAYA, BASSAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:A
Last Name:HADAYA
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:PO BOX 2768
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2768
Mailing Address - Country:US
Mailing Address - Phone:661-948-1388
Mailing Address - Fax:661-948-1223
Practice Address - Street 1:1759 W AVENUE J
Practice Address - Street 2:STE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2703
Practice Address - Country:US
Practice Address - Phone:661-948-1388
Practice Address - Fax:661-948-1223
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29939207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4056336OtherGROUP CORP TAX ID
CAOOA299390Medicaid
CAA25917Medicare UPIN
CA110040126Medicare PIN
CA95-4056336OtherGROUP CORP TAX ID