Healthcare Provider Details

I. General information

NPI: 1699093104
Provider Name (Legal Business Name): ALI RAZFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 12/06/2021
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 WOODMAN AVE BUILDING 5 AREA 220
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-1737
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301106768
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA118700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: