Provider Demographics
NPI:1053545285
Name:SEDRAK, MARK F (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:SEDRAK
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 1:21350 HAWTHORNE BLVD.
Mailing Address - Street 2:SUITE 176
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-540-6908
Mailing Address - Fax:310-540-6721
Practice Address - Street 1:21350 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 176
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5605
Practice Address - Country:US
Practice Address - Phone:310-540-6908
Practice Address - Fax:310-540-6721
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95140174400000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0772189Medicare UPIN