Provider Demographics
NPI:1295093490
Name:SEPIDEH KAZEMI MD INC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SEPIDEH KAZEMI MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-241-3476
Mailing Address - Street 1:16300 SAND CANYON AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3706
Mailing Address - Country:US
Mailing Address - Phone:949-453-9393
Mailing Address - Fax:949-453-9494
Practice Address - Street 1:16300 SAND CANYON AVE STE 601
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3706
Practice Address - Country:US
Practice Address - Phone:949-241-3476
Practice Address - Fax:949-341-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGE904AMedicare PIN