Provider Demographics
NPI:1477665875
Name:PERRY B. SHEIDAYI, D.O., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PERRY B. SHEIDAYI, D.O., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:BEHROOZ
Authorized Official - Last Name:SHEIDAYI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-650-5771
Mailing Address - Street 1:18 ENDEAVOR STE 201
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3181
Mailing Address - Country:US
Mailing Address - Phone:949-650-5771
Mailing Address - Fax:949-340-3967
Practice Address - Street 1:18 ENDEAVOR STE 201
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3181
Practice Address - Country:US
Practice Address - Phone:949-650-5771
Practice Address - Fax:949-340-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17052OtherMEDICARE ID
CA00AX78000Medicaid
CAW17052OtherMEDICARE ID