Healthcare Provider Details

I. General information

NPI: 1982921862
Provider Name (Legal Business Name): SEKSAN SREPHICHIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12156 ADRIAN ST #9-307
GARDEN GROVE CA
92840-4355
US

IV. Provider business mailing address

12156 ADRIAN ST #9-307
GARDEN GROVE CA
92840-4355
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-8310
  • Fax:
Mailing address:
  • Phone: 310-721-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA103108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: