Provider Demographics
NPI:1467540229
Name:SEBASTIAN, QUYNH L (MD)
Entity Type:Individual
Prefix:DR
First Name:QUYNH
Middle Name:L
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 709
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-917-4433
Mailing Address - Fax:310-917-4432
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 709
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-917-4433
Practice Address - Fax:310-917-4432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA064443207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA64443AOtherPROVIDER PIN NUMBER
CAH21399Medicare UPIN
CAW18517Medicare ID - Type UnspecifiedGROUP NUMBER