Provider Demographics
NPI:1720221393
Name:ALI MAHTABIFARD M D INC
Entity Type:Organization
Organization Name:ALI MAHTABIFARD M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHTABIFARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-5052
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-652-5052
Mailing Address - Fax:310-652-5062
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-652-5052
Practice Address - Fax:310-652-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty