Provider Demographics
NPI:1275818122
Name:SEJAL M PATEL MD INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SEJAL M PATEL MD INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-652-8801
Mailing Address - Street 1:541 S SPRING
Mailing Address - Street 2:STE 1201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1667
Mailing Address - Country:US
Mailing Address - Phone:424-652-8801
Mailing Address - Fax:310-362-0319
Practice Address - Street 1:17900 VON KARMAN AVE
Practice Address - Street 2:STE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4296
Practice Address - Country:US
Practice Address - Phone:424-652-8801
Practice Address - Fax:310-362-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104427208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty