Healthcare Provider Details

I. General information

NPI: 1669653101
Provider Name (Legal Business Name): NAYYER Z. ALI, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST #400
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

19601 DEARBORNE CIR
HUNTINGTON BEACH CA
92648-6648
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-6040
  • Fax: 562-427-2565
Mailing address:
  • Phone: 714-739-5959
  • Fax: 714-739-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG69091
License Number StateCA

VIII. Authorized Official

Name: MR. NAYYER Z ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 714-739-5959