Healthcare Provider Details

I. General information

NPI: 1023751682
Provider Name (Legal Business Name): ALI ESSAM AL-TIMIMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax: 415-476-4818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA202352
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA202352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: