Provider Demographics
NPI:1982921862
Name:SREPHICHIT, SEKSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEKSAN
Middle Name:
Last Name:SREPHICHIT
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 1:12156 ADRIAN ST
Mailing Address - Street 2:#9-307
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4355
Mailing Address - Country:US
Mailing Address - Phone:310-721-8310
Mailing Address - Fax:
Practice Address - Street 1:12156 ADRIAN ST
Practice Address - Street 2:#9-307
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4355
Practice Address - Country:US
Practice Address - Phone:310-721-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103108207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK753XMedicare PIN