Provider Demographics
NPI:1174504443
Name:ALI, MOHAMED REDA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:REDA
Last Name:ALI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-4596
Mailing Address - Fax:916-734-3951
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-4596
Practice Address - Fax:916-734-3951
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-11-01
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Provider Licenses
StateLicense IDTaxonomies
CAA80020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA08642OtherPI#
CA08642OtherPI#
00A800200Medicare PIN