Individual
DR. MOHAMMAD ALI ANSARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6310 SAN VICENTE BLVD, SUITE 280, LOS ANGELES, CA 90048-5426
(323) 934-9265
(323) 934-9266
Mailing address
PO BOX 935, BEVERLY HILLS, CA 90213-0935
(310) 433-2750
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G75046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G750460
—
CA
01
—
20-2917859
FEDERAL TAX I.D. NUMBER
CA
01
—
G75046
LICENSE NUMBER
CA
Enumeration date
09/20/2006
Last updated
05/29/2013
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