Provider Demographics
NPI:1134240849
Name:BAYAA, KHALED NAIM (KHALED BAYAA)
Entity type:Individual
Prefix:MR
First Name:KHALED
Middle Name:NAIM
Last Name:BAYAA
Suffix:
Gender:M
Credentials:KHALED BAYAA
Other - Prefix:
Other - First Name:KHALED
Other - Middle Name:NAIM
Other - Last Name:BAYAA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KHALED BAYAA
Mailing Address - Street 1:44 EAGLE PT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3352
Mailing Address - Country:US
Mailing Address - Phone:949-697-4006
Mailing Address - Fax:
Practice Address - Street 1:44 EAGLE PT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3352
Practice Address - Country:US
Practice Address - Phone:949-697-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist