Provider Demographics
NPI:1942311246
Name:KAYALEH, RAOUF A (MD)
Entity Type:Individual
Prefix:MR
First Name:RAOUF
Middle Name:A
Last Name:KAYALEH
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 18376
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817
Mailing Address - Country:US
Mailing Address - Phone:714-279-0711
Mailing Address - Fax:714-541-8448
Practice Address - Street 1:1125 E 17TH STREET SUITE E-109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-279-0711
Practice Address - Fax:714-541-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41449207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C414491Medicaid
A37602Medicare UPIN
CA00C414491Medicaid