Provider Demographics
NPI:1396114401
Name:FORGHANI, ALI
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:FORGHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S CAMINO GRANDE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4920
Mailing Address - Country:US
Mailing Address - Phone:714-381-4291
Mailing Address - Fax:
Practice Address - Street 1:1 W BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1014
Practice Address - Country:US
Practice Address - Phone:973-684-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02618100122300000X
CA1056621223E0200X
NY0591341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105662OtherN/A