Provider Demographics
NPI:1659346021
Name:SAJJADIAN, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:SAJJADIAN
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 1:496 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4263
Mailing Address - Country:US
Mailing Address - Phone:949-515-0550
Mailing Address - Fax:949-515-0551
Practice Address - Street 1:496 OLD NEWPORT BLVD.
Practice Address - Street 2:SUITE #3
Practice Address - City:NEWPORT BLVD.
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-515-0550
Practice Address - Fax:949-515-0551
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056825L174400000X
CAG87722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001956823Medicaid
PA001956823Medicaid
PA070264FKYMedicare ID - Type Unspecified