Provider Demographics
NPI:1295934610
Name:SULTANALI ALIDINA M.D., INC.
Entity type:Organization
Organization Name:SULTANALI ALIDINA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTANALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-630-3434
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-630-3434
Mailing Address - Fax:562-630-5240
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-630-3434
Practice Address - Fax:562-630-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47735207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22625Medicare UPIN
CAWA47735AMedicare PIN