Provider Demographics
NPI:1518074707
Name:ALI R. TAJIK, MD, INC
Entity Type:Organization
Organization Name:ALI R. TAJIK, MD, INC
Other - Org Name:ALI R. TAJIK, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:TAJIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-887-9942
Mailing Address - Street 1:2426 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7222
Mailing Address - Country:US
Mailing Address - Phone:323-887-9942
Mailing Address - Fax:323-887-9949
Practice Address - Street 1:2426 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7222
Practice Address - Country:US
Practice Address - Phone:323-887-9942
Practice Address - Fax:323-887-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629020268OtherNPI - ANAHEIM LOCATION
CAW19738AMedicare ID - Type UnspecifiedMONTEREY PARK, CA