Provider Demographics
NPI:1447292966
Name:XIE, SEAN (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-2077
Mailing Address - Country:US
Mailing Address - Phone:213-977-1102
Mailing Address - Fax:213-977-0656
Practice Address - Street 1:1414 S GRAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3067
Practice Address - Country:US
Practice Address - Phone:213-977-1102
Practice Address - Fax:213-977-0656
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85370207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A853700Medicaid
CA201039443OtherFEDERAL TAX ID
CA00A853700Medicaid
CA201039443OtherFEDERAL TAX ID
CAWA85370AMedicare ID - Type Unspecified