Healthcare Provider Details

I. General information

NPI: 1982865606
Provider Name (Legal Business Name): SEPIDEH GHOLAMI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UC DAVIS CANCER CENTER 4501 X STREET SUITE 3010
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

UC DAVIS CANCER CENTER 4501 X STREET SUITE 3010
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2843
  • Fax: 916-703-5267
Mailing address:
  • Phone: 916-734-2843
  • Fax: 916-703-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberA109810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA109810
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA109810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: