Provider Demographics
NPI:1760589790
Name:ALI, KHURRAM (MD)
Entity Type:Individual
Prefix:
First Name:KHURRAM
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 1:1650 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3400
Mailing Address - Country:US
Mailing Address - Phone:916-986-4426
Mailing Address - Fax:
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-537-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78767208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787670OtherBLUE SHIELD
CA000810610904OtherPHCS
CA106121OtherHEALTH NET
CA236625OtherINTERPLAN
CAMCMG345800OtherWESTERN HEALTH ADVANTAGE
CA2240134OtherFIRST HEALTH
CA7766597OtherAETNA
CA8853749OtherCIGNA
CA1855891OtherGREAT WEST
CAA78767OtherBLUE CROSS
CA00A787670Medicaid
CA90143520OtherPACIFICARE
CA236625OtherINTERPLAN
H03961Medicare UPIN