Healthcare Provider Details

I. General information

NPI: 1194110163
Provider Name (Legal Business Name): ALI AL-SALEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S WEIR CANYON RD STE 167
ANAHEIM CA
92808-1962
US

IV. Provider business mailing address

751 S WEIR CANYON RD STE 167
ANAHEIM CA
92808-1962
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-0611
  • Fax: 714-221-2299
Mailing address:
  • Phone: 714-974-0611
  • Fax: 714-221-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number143365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: