Provider Demographics
NPI:1033387170
Name:ALIREZA JAFARI MD INC
Entity Type:Organization
Organization Name:ALIREZA JAFARI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-945-7746
Mailing Address - Street 1:10053 WHITTWOOD DR UNIT 1218
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-0412
Mailing Address - Country:US
Mailing Address - Phone:562-945-7746
Mailing Address - Fax:562-945-6619
Practice Address - Street 1:14350 WHITTIER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2152
Practice Address - Country:US
Practice Address - Phone:562-945-7746
Practice Address - Fax:562-945-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49135207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033387170Medicaid
CAA49135Medicare PIN