Provider Demographics
NPI:1831286822
Name:AMBIKA BALI MD INC
Entity Type:Organization
Organization Name:AMBIKA BALI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-999-0909
Mailing Address - Street 1:PO BOX 5216
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622-5216
Mailing Address - Country:US
Mailing Address - Phone:714-999-0909
Mailing Address - Fax:714-999-0906
Practice Address - Street 1:1211 W LA PALMA AVE STE 409
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2806
Practice Address - Country:US
Practice Address - Phone:714-999-0909
Practice Address - Fax:714-999-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051761207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A517610Medicaid
CA00A517610Medicaid