Provider Demographics
NPI:1295874022
Name:SARRAF, EDMOND GIDON (MD)
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:GIDON
Last Name:SARRAF
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:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213
Mailing Address - Country:US
Mailing Address - Phone:310-888-7778
Mailing Address - Fax:310-888-7732
Practice Address - Street 1:955 CARRILLO DR STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-888-7778
Practice Address - Fax:310-888-7732
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87551208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics