Provider Demographics
NPI:1508936592
Name:ALAVI, ALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:S
Last Name:ALAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 SUNNYCREST DR
Mailing Address - Street 2:#3400
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3638
Mailing Address - Country:US
Mailing Address - Phone:714-879-2410
Mailing Address - Fax:714-879-5340
Practice Address - Street 1:1950 SUNNYCREST DR
Practice Address - Street 2:#3400
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-879-2410
Practice Address - Fax:714-879-5340
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT122109208800000X
CAA79874208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79874Medicaid
CAGR0011581OtherMEDI-CAL GROUP NUMBER
CA208800000XOtherTAXONOMY
CA1851498133OtherGROUP NPI
CA05D0684380OtherCLIA
CA05D0977537OtherCLIA
CA05D0552498OtherCLIA
CAYYY49655YOtherBLUE SHEILD GRP NUMBER
CA208800000XOtherTAXONOMY
CAW450Medicare PIN
CAWA79874CMedicare PIN
CAGR0011581OtherMEDI-CAL GROUP NUMBER
CAW450BMedicare PIN
CA05D0552498OtherCLIA
CAYYY49655YOtherBLUE SHEILD GRP NUMBER