Provider Demographics
NPI:1376564484
Name:EBRAHIM SAJEDI MD. INC.
Entity Type:Organization
Organization Name:EBRAHIM SAJEDI MD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-1600
Mailing Address - Street 1:2222 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2304
Mailing Address - Country:US
Mailing Address - Phone:310-828-1600
Mailing Address - Fax:310-829-9362
Practice Address - Street 1:2222 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2304
Practice Address - Country:US
Practice Address - Phone:310-828-1600
Practice Address - Fax:310-829-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A622640Medicaid
CAA62264Medicare ID - Type Unspecified
CAG73414Medicare UPIN