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General NPI Number Information
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NPI Number | 1043269194
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Entity Type | Individual
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Provider Name | ALI JOHN ENAYATI M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E SUITE 1806
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City | LOS ANGELES
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State | CA
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Zip | 90067-2001
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Country | US
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Telephone | 310-551-1711
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Fax | 310-551-1311
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E SUITE 1806
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City | LOS ANGELES
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State | CA
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Zip | 90067-2001
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Country | US
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Telephone | 310-551-1711
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Fax | 310-551-1311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A73998
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License Number State | CA
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