Provider Demographics
NPI:1154669315
Name:KATY M. SETOODEH, MD, INC
Entity Type:Organization
Organization Name:KATY M. SETOODEH, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:MELODY
Authorized Official - Last Name:SETOODEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-701-9790
Mailing Address - Street 1:8750 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2703
Mailing Address - Country:US
Mailing Address - Phone:310-701-9790
Mailing Address - Fax:310-595-1022
Practice Address - Street 1:8750 WILSHIRE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2703
Practice Address - Country:US
Practice Address - Phone:310-701-9790
Practice Address - Fax:310-595-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BG803Medicare PIN