MEDICARE: IHAWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1790125862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHAWA

Provider Business Mailing Address
First Line	:	1504 COUPLES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2155
Country	:	US
Telephone Number	:	702-527-1463
Fax Number	:	888-959-8990

Provider Business Practice Location Address
First Line	:	1504 COUPLES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2155
Country	:	US
Telephone Number	:	702-527-1463
Fax Number	:	888-959-8990

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALI JAI AL ZAKAR FAISON
Credential	:
Telephone Number	:	702-527-1463

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/03/2013

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Directions to “IHAWA ” Practice Location

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