Provider Demographics
NPI:1629008941
Name:SEDIGHI, HOOMAN (MD)
Entity Type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:SEDIGHI
Suffix:
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 1:1420 W MOCKINGBIRD LN
Mailing Address - Street 2:STE. 420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4931
Mailing Address - Country:US
Mailing Address - Phone:214-267-0101
Mailing Address - Fax:214-267-8787
Practice Address - Street 1:1420 W MOCKINGBIRD LN
Practice Address - Street 2:STE. 420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4931
Practice Address - Country:US
Practice Address - Phone:214-267-0101
Practice Address - Fax:214-267-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2786225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035BMOtherBC/BS GROUP
TX120434903Medicaid
TX4418351OtherAETNA
TX84961FOtherBC/BS INDIVIDUAL
TX84961FMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TX120434903Medicaid
TX84961FOtherBC/BS INDIVIDUAL
TX0035BMMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER