Provider Demographics
NPI:1184603102
Name:NAMAZIE, ALI R (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:NAMAZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:#505
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5436
Mailing Address - Country:US
Mailing Address - Phone:818-986-5500
Mailing Address - Fax:818-986-5503
Practice Address - Street 1:16661 VENTURA BLVD STE 226
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1947
Practice Address - Country:US
Practice Address - Phone:818-986-5500
Practice Address - Fax:818-986-5503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60291207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602910Medicaid
CA00A602910OtherBLUE SHIELD
H34943Medicare UPIN