Provider Demographics
NPI:1316931934
Name:FAYED, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:FAYED
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:PO BOX 28900
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729
Mailing Address - Country:US
Mailing Address - Phone:559-228-4205
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:2335 E KASHIAN LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2230
Practice Address - Country:US
Practice Address - Phone:559-445-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA546454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A564540Medicaid
CA00A564546Medicare PIN
CA00A564549Medicare PIN
CA00A5645410Medicare PIN
CAG96334Medicare UPIN
CA00A564548Medicare PIN
CA00A564542Medicare PIN
CA00A564543Medicare PIN
CA110190408Medicare PIN
CA00A564544Medicare PIN
CA00A564545Medicare PIN
CA00A564540Medicare PIN
CA00A564547Medicare PIN
CA00A564541Medicare PIN