Healthcare Provider Details

I. General information

NPI: 1306758297
Provider Name (Legal Business Name): SHAWN SEDGH MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 DEER RUN LN
LOS ANGELES CA
90049-6829
US

IV. Provider business mailing address

2097 DEER RUN LN
LOS ANGELES CA
90049-6829
US

V. Phone/Fax

Practice location:
  • Phone: 310-362-5229
  • Fax: 310-496-6774
Mailing address:
  • Phone: 818-481-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN SEDGH
Title or Position: CEO
Credential: MD
Phone: 818-481-6916