Provider Demographics
NPI:1053433540
Name:HISHAM SEIFY MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HISHAM SEIFY MD PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEIFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-251-1502
Mailing Address - Street 1:PO BOX 80157
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0157
Mailing Address - Country:US
Mailing Address - Phone:949-251-1502
Mailing Address - Fax:949-251-1522
Practice Address - Street 1:20301 SW BIRCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1754
Practice Address - Country:US
Practice Address - Phone:949-251-1502
Practice Address - Fax:948-251-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91590208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty