Provider Demographics
NPI:1407981731
Name:MOHAMED S ALI MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MOHAMED S ALI MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-732-2732
Mailing Address - Street 1:10165 FOOTHILL BLVD
Mailing Address - Street 2:#26
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0340
Mailing Address - Country:US
Mailing Address - Phone:909-481-0800
Mailing Address - Fax:909-481-0700
Practice Address - Street 1:10165 FOOTHILL BLVD
Practice Address - Street 2:#26
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0340
Practice Address - Country:US
Practice Address - Phone:909-481-0800
Practice Address - Fax:909-481-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26335ZMedicare PIN
CAH10123Medicare UPIN