MEDICARE: ALI JOHN ENAYATI MD MPH PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1124214150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI JOHN ENAYATI MD MPH PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2080 CENTURY PARK E STE 1806
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2009
Country	:	US
Telephone Number	:	310-551-1711
Fax Number	:	310-551-1311

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 1806
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2021
Country	:	US
Telephone Number	:	310-551-1711
Fax Number	:	310-551-1311

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LIZANNE ELAINE WEBB
Credential	:
Telephone Number	:	646-298-6422

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/12/2018

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