Provider Demographics
NPI:1558357319
Name:NIKRAVAN, SEAN P (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:NIKRAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 PLACENTIA AVE
Mailing Address - Street 2:STE 99
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3301
Mailing Address - Country:US
Mailing Address - Phone:949-650-0600
Mailing Address - Fax:866-293-0414
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:STE 99
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3301
Practice Address - Country:US
Practice Address - Phone:949-650-0616
Practice Address - Fax:949-650-0600
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80371207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80371OtherSTATE LICENSE
CAA80371OtherSTATE LICENSE