Provider Demographics
NPI:1003914383
Name:ALI MOAYED MD INC MED GRP
Entity Type:Organization
Organization Name:ALI MOAYED MD INC MED GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-1199
Mailing Address - Street 1:16400 LARK AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2547
Mailing Address - Country:US
Mailing Address - Phone:408-356-1199
Mailing Address - Fax:408-356-5344
Practice Address - Street 1:16400 LARK AVE
Practice Address - Street 2:STE 300
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2547
Practice Address - Country:US
Practice Address - Phone:408-356-1199
Practice Address - Fax:408-356-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23298ZMedicare ID - Type Unspecified