Healthcare Provider Details

I. General information

NPI: 1184687816
Provider Name (Legal Business Name): ALI DOCTOR FOROOTAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRAMERCY UNIT 403
IRVINE CA
92612-0013
US

IV. Provider business mailing address

21 GRAMERCY UNIT 403
IRVINE CA
92612-0013
US

V. Phone/Fax

Practice location:
  • Phone: 214-680-1490
  • Fax: 949-679-2730
Mailing address:
  • Phone: 214-680-1490
  • Fax: 949-679-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC135342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: