Healthcare Provider Details

I. General information

NPI: 1104159383
Provider Name (Legal Business Name): SEPER DEZFOLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 411
LONG BEACH CA
90808-2146
US

IV. Provider business mailing address

3816 WOODRUFF AVE STE 411
LONG BEACH CA
90808-2146
US

V. Phone/Fax

Practice location:
  • Phone: 562-485-5550
  • Fax:
Mailing address:
  • Phone: 562-485-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036169574
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA113069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: