Provider Demographics
NPI:1891759908
Name:SOOZANI, ALI (DO PHD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SOOZANI
Suffix:
Gender:M
Credentials:DO PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2577 SAMARITAN DRIVE
Mailing Address - Street 2:STE 855F
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-402-9521
Mailing Address - Fax:408-402-9931
Practice Address - Street 1:2577 SAMARITAN DRIVE
Practice Address - Street 2:STE 855F
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-402-9521
Practice Address - Fax:408-402-9931
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7210208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60067034OtherTAT
CAZZZ01403ZOtherBLUE CROSS
CA00AX72100Medicaid
CA60067034OtherTAT
G71594Medicare UPIN