Provider Demographics
NPI:1366820540
Name:SEDIQE, SOUD I (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUD
Middle Name:
Last Name:SEDIQE
Suffix:I
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 1:8555 AERO DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1744
Mailing Address - Country:US
Mailing Address - Phone:858-650-5036
Mailing Address - Fax:858-650-5039
Practice Address - Street 1:8008 FROST ST STE 401
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4209
Practice Address - Country:US
Practice Address - Phone:858-309-5931
Practice Address - Fax:858-810-6908
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171978207R00000X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program