Provider Demographics
NPI:1063629079
Name:SEDAGHAT, CYRUS SHARUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:SHARUZ
Last Name:SEDAGHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NASSER
Other - Middle Name:
Other - Last Name:SEDAGHAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:316 GIOTTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8579
Mailing Address - Country:US
Mailing Address - Phone:949-228-1022
Mailing Address - Fax:
Practice Address - Street 1:18800 DELAWARE ST STE 1100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6021
Practice Address - Country:US
Practice Address - Phone:949-228-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1087512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine