Basic Information
| Provider Information | |||||||||
| NPI: | 1245672815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAIF JAWID | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | WASAY | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 W KETTLEMAN LN | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952424337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 E 31ST ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103474141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2013 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A140424 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.