Provider Demographics
NPI:1063411684
Name:ALIDINA, SULTANALI (MD)
Entity type:Individual
Prefix:
First Name:SULTANALI
Middle Name:
Last Name:ALIDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-630-3434
Mailing Address - Fax:562-630-5240
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-630-3434
Practice Address - Fax:562-630-5240
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47735207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477350Medicaid
E96634Medicare UPIN
CAA47735Medicare ID - Type Unspecified