Healthcare Provider Details

I. General information

NPI: 1255200499
Provider Name (Legal Business Name): MR. CALVIN SAEPHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 41ST AVE
SACRAMENTO CA
95824-2833
US

IV. Provider business mailing address

4200 41ST AVE
SACRAMENTO CA
95824-2833
US

V. Phone/Fax

Practice location:
  • Phone: 916-751-9588
  • Fax:
Mailing address:
  • Phone: 916-751-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: