Healthcare Provider Details

I. General information

NPI: 1306075585
Provider Name (Legal Business Name): SEFI CHEN KHAMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

10114 ISLE WYND CT
BOYNTON BEACH FL
33437-5501
US

V. Phone/Fax

Practice location:
  • Phone: 561-929-6720
  • Fax: 203-855-3589
Mailing address:
  • Phone: 561-929-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME118313
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 118313
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54270
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME118313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: