Basic Information
| Provider Information | |||||||||
| NPI: | 1871547075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEGINI | ||||||||
| FirstName: | SEPIDEH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FARAHANI | ||||||||
| OtherFirstName: | SEPIDEH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627414421 | ||||||||
| FaxNumber: | 5627414479 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 LAKEWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902404020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628623684 | ||||||||
| FaxNumber: | 5628627145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A78691 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A786910 | 01 | CA | BLUE SHIELD ID # | OTHER | 00A786910 | 05 | CA | MEDICAID |