Healthcare Provider Details

I. General information

NPI: 1245599687
Provider Name (Legal Business Name): ALI JAVOD SHEIKHIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD 4TH FLOOR
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

531 ESPLANADE 211
REDONDO BEACH CA
90277-4058
US

V. Phone/Fax

Practice location:
  • Phone: 360-888-7552
  • Fax:
Mailing address:
  • Phone: 360-888-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122793
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number21107
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: