Basic Information
| Provider Information | |||||||||
| NPI: | 1740470855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALIJANI | ||||||||
| FirstName: | ATA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1304 FAWCETT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2537614201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FAWCETT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2537614201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | A100708 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | MD60507050 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | MD190076 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | A100708 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD190076 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD60507050 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0339463 | 01 | WA | LNI-DIAGNOSTIC IMAGING NW | OTHER | 2040820 | 05 | WA | MEDICAID | 0365616 | 01 | WA | LNI-UNION AVE OPEN MRI | OTHER | 0362601 | 01 | WA | LNI-TRA-MINW-REST OF WA | OTHER | 0362603 | 01 | WA | LNI-TRA-MINW-KING CTY | OTHER |