Provider Demographics
NPI:1629028048
Name:ALI, NAYYER (MD)
Entity Type:Individual
Prefix:DR
First Name:NAYYER
Middle Name:
Last Name:ALI
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 1:19601 DEARBORNE CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6648
Mailing Address - Country:US
Mailing Address - Phone:562-424-6040
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:STE 400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-424-6040
Practice Address - Fax:562-427-2565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69091OtherB/S PROVIDER NO
CA00G690910Medicaid
CAG69091OtherB/S PROVIDER NO
CAWG69091GMedicare ID - Type UnspecifiedMCARE PROVIDER NO