Provider Demographics
NPI:1841603586
Name:ALI AHMAD MEDICAL CORP
Entity Type:Organization
Organization Name:ALI AHMAD MEDICAL CORP
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:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-596-0400
Mailing Address - Street 1:350 W 5TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2751
Mailing Address - Country:US
Mailing Address - Phone:424-477-5576
Mailing Address - Fax:424-299-4186
Practice Address - Street 1:350 W 5TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2751
Practice Address - Country:US
Practice Address - Phone:424-477-5576
Practice Address - Fax:424-299-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC127870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB246770OtherMEDICARE PTAN