MEDICARE: KEVIN SOHI SADATI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery Physician	20A9343	CA

General Provider Information

NPI Number	:	1053490003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SOHI SADATI DO

Provider Business Mailing Address
First Line	:	27462 PASEO BOVEDA
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1890
Country	:	US
Telephone Number	:	949-481-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NEWPORT CENTER DRIVE
Second Line	:	SUITE 100
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660
Country	:	US
Telephone Number	:	949-706-7776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/23/2009

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