Provider Demographics
NPI:1871547075
Name:CHEGINI, SEPIDEH (MD)
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:CHEGINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEPIDEH
Other - Middle Name:
Other - Last Name:FARAHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4421
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:10000 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4020
Practice Address - Country:US
Practice Address - Phone:562-862-3684
Practice Address - Fax:562-862-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786910OtherBLUE SHIELD ID #
CA00A786910Medicaid
H73146Medicare UPIN
CAWA78691BMedicare PIN
CAWA78691CMedicare PIN