Provider Demographics
NPI:1821296591
Name:KAWAYEH, ANAS (MD)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:
Last Name:KAWAYEH
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 1:375 TERRACINA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3801
Mailing Address - Country:US
Mailing Address - Phone:909-883-2394
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:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109588207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109588OtherMD LICENSE