Provider Demographics
NPI:1366499832
Name:A AMOLI MD INC
Entity Type:Organization
Organization Name:A AMOLI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:ABED
Authorized Official - Last Name:AMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-636-1622
Mailing Address - Street 1:6170 THORNTON AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3700
Mailing Address - Country:US
Mailing Address - Phone:510-636-1622
Mailing Address - Fax:510-857-5847
Practice Address - Street 1:6170 THORNTON AVE
Practice Address - Street 2:SUITE H
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3700
Practice Address - Country:US
Practice Address - Phone:510-636-1622
Practice Address - Fax:510-857-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366499832OtherNPI CORPORATION
CAZZZ03843ZOtherPTEN
CA1861595233OtherNPI PERSONAL
CA1366499832OtherNPI CORPORATION
CA1366499832OtherNPI CORPORATION