Provider Demographics
NPI:1649756164
Name:SEPER DEZFOLI, MD, INC
Entity type:Organization
Organization Name:SEPER DEZFOLI, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEPER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZFOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-800-1000
Mailing Address - Street 1:369 S DOHENY DR STE 1121
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3508
Mailing Address - Country:US
Mailing Address - Phone:323-800-1000
Mailing Address - Fax:877-239-0994
Practice Address - Street 1:250 N ROBERTSON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1767
Practice Address - Country:US
Practice Address - Phone:323-800-1000
Practice Address - Fax:877-239-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty