Provider Demographics
NPI:1245318088
Name:BEHZADNIA, ALI ASGHAR (MD FACP)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:ASGHAR
Last Name:BEHZADNIA
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 VICTORIA ST
Mailing Address - Street 2:#2J
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-650-0630
Mailing Address - Fax:949-650-3754
Practice Address - Street 1:275 VICTORIA ST
Practice Address - Street 2:#2J
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-650-0630
Practice Address - Fax:949-650-3754
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39541207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395410Medicaid
CAA39541Medicare ID - Type Unspecified
CA00A395410Medicaid