Provider Demographics
NPI:1295955938
Name:ALI, ALIJA (DO)
Entity type:Individual
Prefix:
First Name:ALIJA
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 1:13470 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-3436
Mailing Address - Country:US
Mailing Address - Phone:562-906-7766
Mailing Address - Fax:562-906-7763
Practice Address - Street 1:13470 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3436
Practice Address - Country:US
Practice Address - Phone:562-906-7766
Practice Address - Fax:562-906-7763
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6561207Q00000X, 207R00000X, 207VX0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295955938Medicaid
1568663573Medicare NSC
W14049Medicare ID - Type Unspecified
FG8323Medicare UPIN