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General NPI Number Information
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NPI Number | 1770902900
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Entity Type | Organization
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Legal Business Name | RAOUF A KAYALEH MD PROF MEDICAL CORP
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST SUITE E-109
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 909-374-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST SUITE E-109
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 909-374-0804
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAOUF ANTOINE KAYALEH
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Credential | M.D.
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Telephone | 714-279-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | C41449
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C41449
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License Number State | CA
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