Provider Demographics
NPI:1316061674
Name:ABAIAN, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ABAIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22481 QUIET BAY DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5667
Mailing Address - Country:US
Mailing Address - Phone:323-581-7400
Mailing Address - Fax:323-581-5500
Practice Address - Street 1:8460 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-3761
Practice Address - Country:US
Practice Address - Phone:323-581-7400
Practice Address - Fax:323-581-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72830207UN0902X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A728300Medicaid