Healthcare Provider Details

I. General information

NPI: 1174436117
Provider Name (Legal Business Name): LDA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 WILSHIRE BLVD STE 685
SANTA MONICA CA
90403
US

IV. Provider business mailing address

2632 WILSHIRE BLVD STE 685
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-424-7013
  • Fax: 239-999-1340
Mailing address:
  • Phone: 310-424-7013
  • Fax: 239-999-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI J ENAYATI
Title or Position: MEDICAL DIRECTOR
Credential: MD, MPH
Phone: 310-424-7013