Provider Demographics
NPI:1669653101
Name:NAYYER Z. ALI, MD INC.
Entity Type:Organization
Organization Name:NAYYER Z. ALI, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAYYER
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-739-5959
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:714-739-5959
Mailing Address - Fax:714-739-5974
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:#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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G690910OtherB/S PROVIDER NO
CA00G690910Medicaid
CA00G690910OtherB/S PROVIDER NO