Provider Demographics
NPI:1427401512
Name:ALI, ASHIM HAYDAR
Entity Type:Individual
Prefix:
First Name:ASHIM
Middle Name:HAYDAR
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 PACIFIC AVE # 544
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3713
Mailing Address - Country:US
Mailing Address - Phone:619-646-0416
Mailing Address - Fax:
Practice Address - Street 1:4578 FEATHER RIVER DR STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6510
Practice Address - Country:US
Practice Address - Phone:619-646-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00100912247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist