Provider Demographics
NPI:1104037506
Name:SADIGHI, SAEID (MD)
Entity Type:Individual
Prefix:
First Name:SAEID
Middle Name:
Last Name:SADIGHI
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 1:2701 FIRESTONE BLVD W
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2778
Mailing Address - Country:US
Mailing Address - Phone:323-249-6162
Mailing Address - Fax:323-563-0820
Practice Address - Street 1:2701 FIRESTONE BLVD
Practice Address - Street 2:SUITE W
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2778
Practice Address - Country:US
Practice Address - Phone:323-249-6162
Practice Address - Fax:323-563-0820
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA465722085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46572OtherPRIVATE
CA00A465720Medicaid
CAWA46572EMedicare ID - Type UnspecifiedMEDICARE RENDERING NUMBER
CA00A465720Medicaid