Healthcare Provider Details

I. General information

NPI: 1720928344
Provider Name (Legal Business Name): YAZAN FAHD HAWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

1601 BARTON RD APT 1306
REDLANDS CA
92373-4384
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-2811
  • Fax:
Mailing address:
  • Phone: 909-253-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: