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General NPI Number Information
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NPI Number | 1861640302
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Entity Type | Individual
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Provider Name | ALI OSTADALI MAKHMALBAF
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Gender | Male
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/11/2011
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Provider Practice Location Address
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Address Line | 925 W 34TH ST # 230
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City | LOS ANGELES
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State | CA
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Zip | 90089-0058
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Country | US
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Telephone | 714-495-0414
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Fax |
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Provider Business Mailing Address
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Address Line | 442 S PASEO SERENA
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City | ANAHEIM
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State | CA
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Zip | 92807-4214
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412149
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 59489
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 25978
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License Number State | TX
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