Provider Demographics
NPI:1225084213
Name:KATIRAIE, SEPEHR (MD)
Entity Type:Individual
Prefix:DR
First Name:SEPEHR
Middle Name:
Last Name:KATIRAIE
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 1:724 N ELM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3423
Mailing Address - Country:US
Mailing Address - Phone:310-446-0093
Mailing Address - Fax:323-277-0399
Practice Address - Street 1:2625 E FLORENCE AVE STE D
Practice Address - Street 2:HUNTINGTON PARK
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4756
Practice Address - Country:US
Practice Address - Phone:323-588-3800
Practice Address - Fax:323-277-0399
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine