Healthcare Provider Details

I. General information

NPI: 1225212988
Provider Name (Legal Business Name): HOMAYOUN SADEGHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S BEVERLY DRIVE #3861
BEVERLY HILLS CA
90212-1985
US

IV. Provider business mailing address

312 S BEVERLY DRIVE #3861
BEVERLY HILLS CA
90212-1985
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-5700
  • Fax:
Mailing address:
  • Phone: 310-278-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number390200000X
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA93041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: