Provider Demographics
NPI:1104159383
Name:DEZFOLI, SEPER (MD)
Entity type:Individual
Prefix:DR
First Name:SEPER
Middle Name:
Last Name:DEZFOLI
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 1:369 S DOHENY DR STE 1121
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3508
Mailing Address - Country:US
Mailing Address - Phone:323-800-1000
Mailing Address - Fax:877-239-0994
Practice Address - Street 1:250 N ROBERTSON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1767
Practice Address - Country:US
Practice Address - Phone:323-800-1000
Practice Address - Fax:877-239-0994
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036169574207RG0100X
CAA113069207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology