Healthcare Provider Details

I. General information

NPI: 1710182779
Provider Name (Legal Business Name): MATTHEW T SIEDHOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR SUITE 101
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

9903 SANTA MONICA BLVD #208
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-997-4884
  • Fax: 310-579-4992
Mailing address:
  • Phone: 310-997-4884
  • Fax: 310-579-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2009-00884
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number138819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: