Provider Demographics
NPI:1710250519
Name:P K SEHDEVA MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:P K SEHDEVA MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARKASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SEHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-263-1400
Mailing Address - Street 1:12321 HAWTHORNE BLVD.
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90252
Mailing Address - Country:US
Mailing Address - Phone:310-263-1400
Mailing Address - Fax:310-263-1418
Practice Address - Street 1:12321 HAWTHORNE BLVD.
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-263-1400
Practice Address - Fax:310-263-1418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P K SEHDEVA MD A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36163207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36163Medicaid
CAA36163Medicaid
CAA36163Medicare PIN