Healthcare Provider Details

I. General information

NPI: 1861328890
Provider Name (Legal Business Name): ALI ZIFAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5954 BROOK RD
RICHMOND VA
23227-2258
US

IV. Provider business mailing address

5954 BROOK RD
RICHMOND VA
23227-2258
US

V. Phone/Fax

Practice location:
  • Phone: 804-398-8327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: