Provider Demographics
NPI:1477393437
Name:ALI AFSHAR MD INC
Entity type:Organization
Organization Name:ALI AFSHAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF-AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-278-1594
Mailing Address - Street 1:414 N CAMDEN DR STE 650
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4513
Mailing Address - Country:US
Mailing Address - Phone:310-278-1594
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR STE 650
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4513
Practice Address - Country:US
Practice Address - Phone:310-278-1549
Practice Address - Fax:310-278-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619315108Medicaid