Joseph F. Sedrak M.D., a Medical Corporation

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

A84538 Issued in CA

Legal business name

JOSEPH F. SEDRAK M.D., A MEDICAL CORPORATION

Practice address

4440 Brockton Ave Ste 200
Riverside, CA 92501-4026

Phone

(951) 858-4595

NPI assigned

Jun 19, 2008

Last updated

Jun 19, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Joseph F Sedrak, M.D.

Title

President/Ceo

Phone

(909) 796-9544

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1952562258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11751 ALMOND CT",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014026",
            "telephone_number": "951-858-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH F. SEDRAK M.D., A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "SEDRAK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "909-796-9544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A84538",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A84538",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A84538",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A845380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.