Healthcare Provider Details

I. General information

NPI: 1386833069
Provider Name (Legal Business Name): ALI SEPEHR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR STE 409
NEWPORT BEACH CA
92660-7822
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 409
NEWPORT BEACH CA
92660-7822
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 Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA93414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA93414
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA93414
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA93414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: