Provider Demographics
NPI:1831213701
Name:DABESTANI, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:DABESTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23022 BOUQUET CYN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1673
Mailing Address - Country:US
Mailing Address - Phone:949-916-8420
Mailing Address - Fax:949-770-7989
Practice Address - Street 1:25401 CABOT RD
Practice Address - Street 2:107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5524
Practice Address - Country:US
Practice Address - Phone:949-770-4858
Practice Address - Fax:949-770-7989
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2012-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA34447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344471Medicaid
CAA34447AMedicare ID - Type Unspecified
CAA27481Medicare UPIN