Provider Demographics
NPI:1003801390
Name:SEYED, KAZEM (MD)
Entity Type:Individual
Prefix:
First Name:KAZEM
Middle Name:
Last Name:SEYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E LATHAM AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4370
Mailing Address - Country:US
Mailing Address - Phone:951-766-6696
Mailing Address - Fax:951-766-6699
Practice Address - Street 1:750 E LATHAM AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4370
Practice Address - Country:US
Practice Address - Phone:951-766-6696
Practice Address - Fax:951-766-6699
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42486207Q00000X, 208000000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C424861Medicaid
CA00C424861Medicaid
E31663Medicare UPIN