Healthcare Provider Details

I. General information

NPI: 1053783258
Provider Name (Legal Business Name): MICHAEL F. SEDRAK, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10336 WILSHIRE BLVD APT 602
LOS ANGELES CA
90024-4754
US

IV. Provider business mailing address

1902 FULLERTON AVE STE 101
CORONA CA
92881-3112
US

V. Phone/Fax

Practice location:
  • Phone: 310-728-0494
  • Fax: 619-209-7888
Mailing address:
  • Phone: 951-479-8994
  • Fax: 619-209-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA82582
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL FAYEZ SEDRAK
Title or Position: PRESIDENT
Credential: MD
Phone: 310-728-0494