Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 50 052367 | NY |
N | 1223P0221X | Pediatric Dentist | 58468 | CA |
NPI | 1053449439 |
---|---|
Provider Name | Dr. Ali Asgari |
First Address | San Marcos, CA 92078-2347 |
Second Address | San Marcos, CA 92078-2347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 04/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02804222 | (05) | NY |
1053449439 | MEDI-CAL (01) | CA |