Healthcare Provider Details

I. General information

NPI: 1396777538
Provider Name (Legal Business Name): ZEID K KAYALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 N RIVERSIDE AVE STE A
RIALTO CA
92377-4697
US

IV. Provider business mailing address

2006 N RIVERSIDE AVE STE A
RIALTO CA
92377-4697
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-2999
  • Fax: 909-883-2997
Mailing address:
  • Phone: 909-883-2999
  • Fax: 909-883-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA71164
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA71164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: