Healthcare Provider Details

I. General information

NPI: 1609564855
Provider Name (Legal Business Name): BAHJAT SAID AYASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOMERIAN HEALTH - HAZZA 'BIN ZAYED THE FIRST ST TAMOUH BUSINESS HUB, BLOCK A, 1ST FLOOR
ABU DHABI ABU DHABI PROVINCE
11111
AE

IV. Provider business mailing address

1647 JUNIPER RIDGE ST
POMONA CA
91766-4113
US

V. Phone/Fax

Practice location:
  • Phone: 50-693-9930
  • Fax:
Mailing address:
  • Phone: 909-973-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA50659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: