Healthcare Provider Details

I. General information

NPI: 1528819141
Provider Name (Legal Business Name): TALAL AL-ASSIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 400
ORANGE CA
92868-2994
US

IV. Provider business mailing address

333 CITY BLVD W STE 400
ORANGE CA
92868-2994
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 714-456-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: