Provider Demographics
NPI:1982153797
Name:ANAS KAWAYEH MD INC
Entity Type:Organization
Organization Name:ANAS KAWAYEH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAYEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-883-2999
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:909-883-2999
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109588207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109588OtherLICENSE