Provider Demographics
NPI:1033183157
Name:AGHAMOHAMMADI, ALI M (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:AGHAMOHAMMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:M
Other - Last Name:AGHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2323 16TH STREET
Mailing Address - Street 2:101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3453
Mailing Address - Country:US
Mailing Address - Phone:661-324-3232
Mailing Address - Fax:661-324-1236
Practice Address - Street 1:2323 16TH STREET
Practice Address - Street 2:101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3453
Practice Address - Country:US
Practice Address - Phone:661-324-3232
Practice Address - Fax:661-324-1236
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41243207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412431Medicaid
CAE33834Medicare UPIN
CA00A412431Medicare ID - Type Unspecified