Healthcare Provider Details

I. General information

NPI: 1447954219
Provider Name (Legal Business Name): PREMIER GASTROENTEROLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S OAK KNOLL AVE
PASADENA CA
91106-4450
US

IV. Provider business mailing address

1150 S OAK KNOLL AVE
PASADENA CA
91106-4450
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-2999
  • Fax:
Mailing address:
  • Phone: 909-883-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANAS KAWAYEH
Title or Position: PRESIDENT
Credential: MD
Phone: 909-709-6933