Khazaeinezhad, Ali

Khazaeinezhad, Ali is an sole proprietor health care provider with primary practice located at 742 W Highland Ave San Marcos Medical Group Inc., San Bernardino CA 92405-3839. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gynecology, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Khazaeinezhad, Ali can be contacted via phone (312) 953-9909.

Contact Information

Primary practice address
742 W Highland Ave San Marcos Medical Group Inc. San Bernardino CA 92405-3839
Phone: (312) 953-9909
Fax: (909) 881-7330
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 250973 Massachusetts
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X A108351 California

Profile Details

NPI number 1669677837
LBN Legal business name Khazaeinezhad, Ali
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 18th, 2007
Last updated Dec 2nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669677837 NPPES
Massachusetts MEDICAID 110093581A

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