Provider Demographics
NPI:1174748123
Name:JAZAYERI, ALI JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:JOHN
Last Name:JAZAYERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6202
Mailing Address - Country:US
Mailing Address - Phone:949-294-3838
Mailing Address - Fax:
Practice Address - Street 1:2700 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6202
Practice Address - Country:US
Practice Address - Phone:949-294-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0533281223G0001X
CA641981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02838737Medicaid
NY03059698Medicaid