Provider Demographics
NPI:1043269194
Name:ENAYATI, ALI JOHN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:JOHN
Last Name:ENAYATI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1806
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-551-1711
Mailing Address - Fax:310-551-1311
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1806
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-551-1711
Practice Address - Fax:310-551-1311
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19702Medicare PIN