Provider Demographics
NPI:1902358575
Name:ALI, BACHAR (DO)
Entity Type:Individual
Prefix:DR
First Name:BACHAR
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CHINO AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1211
Mailing Address - Country:US
Mailing Address - Phone:909-630-7868
Mailing Address - Fax:094-692-1099
Practice Address - Street 1:3110 CHINO AVE # 150
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1211
Practice Address - Country:US
Practice Address - Phone:909-630-7868
Practice Address - Fax:909-469-2109
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020382207Q00000X
CA20A20287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A20287OtherDO CA LICENSE
CA1902358575Medicaid