Healthcare Provider Details

I. General information

NPI: 1295655231
Provider Name (Legal Business Name): MOHAMED H ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 PORTLAND AVE E STE A
TACOMA WA
98445-4199
US

IV. Provider business mailing address

8614 PORTLAND AVE E STE A
TACOMA WA
98445-4199
US

V. Phone/Fax

Practice location:
  • Phone: 253-680-9499
  • Fax:
Mailing address:
  • Phone: 253-680-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: