Provider Demographics
NPI:1568434595
Name:HOUSHYAR, ALI ASGHAR (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:ASGHAR
Last Name:HOUSHYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 N ROSE DR
Mailing Address - Street 2:STE 126
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-524-3880
Mailing Address - Fax:714-524-3884
Practice Address - Street 1:1275 N ROSE DR
Practice Address - Street 2:STE 126
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-524-3880
Practice Address - Fax:714-524-3884
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534120Medicaid
WA53412DMedicare ID - Type Unspecified
CA00A534120Medicaid