Provider Demographics
NPI:1548451297
Name:ALI, EHSAN (MD)
Entity type:Individual
Prefix:
First Name:EHSAN
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:#303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4714
Mailing Address - Country:US
Mailing Address - Phone:310-683-0180
Mailing Address - Fax:310-683-0932
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:#303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4714
Practice Address - Country:US
Practice Address - Phone:310-683-0180
Practice Address - Fax:310-683-0932
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine