Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301106768 | MI |
Y | 207YS0123X | Facial Plastic Surgeon | A118700 | CA |
NPI | 1699093104 |
---|---|
Provider Name | Ali Razfar |
First Address | Riverside, CA 92505-3043 |
Second Address | Panorama City, CA 91402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 06/12/2021 |