Provider Demographics
NPI:1821165143
Name:ALI, SYED OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:OMAR
Last Name:ALI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DR STE 310
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1961
Mailing Address - Country:US
Mailing Address - Phone:818-884-8044
Mailing Address - Fax:818-884-8196
Practice Address - Street 1:7345 MEDICAL CENTER DR STE 310
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1961
Practice Address - Country:US
Practice Address - Phone:818-884-8044
Practice Address - Fax:818-884-8196
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056951207N00000X, 207NS0135X
TXN9338207N00000X
CAC197728207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA179353931Medicaid
GADC4061OtherRAILROAD MEDICARE
GAI71368Medicare UPIN
GAGRP6800Medicare PIN