Healthcare Provider Details

I. General information

NPI: 1891795449
Provider Name (Legal Business Name): RAED ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY STE 240
IRVINE CA
92618-3175
US

IV. Provider business mailing address

113 WATERWORKS WAY STE 240
IRVINE CA
92618-3175
US

V. Phone/Fax

Practice location:
  • Phone: 949-340-9622
  • Fax: 949-528-3969
Mailing address:
  • Phone: 949-340-9622
  • Fax: 949-528-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA61744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: