Provider Demographics
NPI:1477357226
Name:SAN, ALI (DO)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 TROOST AVE UNIT 112
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3268
Mailing Address - Country:US
Mailing Address - Phone:480-347-7316
Mailing Address - Fax:
Practice Address - Street 1:555 W KINZIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5727
Practice Address - Country:US
Practice Address - Phone:480-347-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program