Provider Demographics
NPI:1962447060
Name:ASHRAFZADEH, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ASHRAFZADEH
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 1:5230 PACIFIC CONCOURSE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6200
Mailing Address - Country:US
Mailing Address - Phone:310-297-9221
Mailing Address - Fax:310-297-9222
Practice Address - Street 1:5230 PACIFIC CONCOURSE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6200
Practice Address - Country:US
Practice Address - Phone:310-297-9221
Practice Address - Fax:310-297-9222
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83216207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A832160Medicaid
CA00A832160Medicaid
CAA83216Medicare UPIN