Provider Demographics
NPI:1174350029
Name:ALI, SIMIN (PA-C)
Entity type:Individual
Prefix:
First Name:SIMIN
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S FRY RD STE 350
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2258
Mailing Address - Country:US
Mailing Address - Phone:713-636-2621
Mailing Address - Fax:
Practice Address - Street 1:707 S FRY RD STE 350
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2258
Practice Address - Country:US
Practice Address - Phone:713-636-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant