Healthcare Provider Details

I. General information

NPI: 1174801948
Provider Name (Legal Business Name): SEPEHR MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE STE 201
IRVINE CA
92618-3712
US

IV. Provider business mailing address

16300 SAND CANYON AVE STE 201
IRVINE CA
92618-3712
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-6963
  • Fax: 949-313-7757
Mailing address:
  • Phone: 949-371-6963
  • Fax: 949-313-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA93414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA93414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA93414
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA93414
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA93414
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA93414
License Number StateCA

VIII. Authorized Official

Name: DR. ALI SEPEHR
Title or Position: CEO
Credential: MD
Phone: 949-371-6963