Provider Demographics
NPI:1053529990
Name:SETOODEH, KATY (MD)
Entity type:Individual
Prefix:DR
First Name:KATY
Middle Name:
Last Name:SETOODEH
Suffix:
Gender:F
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:PO BOX 491896
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8896
Mailing Address - Country:US
Mailing Address - Phone:818-986-4064
Mailing Address - Fax:
Practice Address - Street 1:2121 SANTA MONICA BLVD STE 335E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-582-7312
Practice Address - Fax:310-315-6173
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84887207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW932Medicare ID - Type UnspecifiedHEALTH CENTERS
CAW809BMedicare ID - Type UnspecifiedHUDSON