Healthcare Provider Details

I. General information

NPI: 1508494832
Provider Name (Legal Business Name): MR. SAIF ALI AZAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST D&T 3D321
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 714-928-5664
  • Fax:
Mailing address:
  • Phone: 617-243-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1027396
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: