Healthcare Provider Details

I. General information

NPI: 1659329209
Provider Name (Legal Business Name): ALI KHOYNEZHAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 340
LONG BEACH CA
90808-1793
US

IV. Provider business mailing address

3828 SCHAUFELE AVE STE 340
LONG BEACH CA
90808-1793
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-5388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number23507
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA92674
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA92674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: