MEDICARE: DR. BASSAM A HADAYA MD

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	207RN0300X	Nephrology Physician	A29939	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-4056336	OTHER	CA	GROUP CORP TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801864301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSAM A HADAYA MD

Provider Business Mailing Address
First Line	:	PO BOX 2768
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93539-2768
Country	:	US
Telephone Number	:	661-948-1388
Fax Number	:	661-948-1223

Provider Business Practice Location Address
First Line	:	1759 W AVENUE J
Second Line	:	STE 101
City	:	LANCASTER
State	:	CA
Zip	:	93534-2703
Country	:	US
Telephone Number	:	661-948-1388
Fax Number	:	661-948-1223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	02/23/2016

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