Provider Demographics
NPI:1780797902
Name:HADAYA, TAWFIK TIM (MD)
Entity type:Individual
Prefix:DR
First Name:TAWFIK
Middle Name:TIM
Last Name:HADAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44105 N 15TH ST W
Mailing Address - Street 2:#302
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4089
Mailing Address - Country:US
Mailing Address - Phone:661-949-3006
Mailing Address - Fax:661-949-8770
Practice Address - Street 1:38660 MEDICAL CENTER DR # A200
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4385
Practice Address - Country:US
Practice Address - Phone:661-949-3006
Practice Address - Fax:661-949-8770
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39485208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0076830Medicaid
CA1780797902Medicare PIN
CAGR0076830Medicaid