Provider Demographics
NPI:1780807008
Name:SEYOUM, MESFIN (MD)
Entity type:Individual
Prefix:DR
First Name:MESFIN
Middle Name:
Last Name:SEYOUM
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 1:522 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5814
Mailing Address - Country:US
Mailing Address - Phone:323-752-0783
Mailing Address - Fax:323-752-0783
Practice Address - Street 1:2710 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2436
Practice Address - Country:US
Practice Address - Phone:323-778-4310
Practice Address - Fax:323-778-0838
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine