MEDICARE: SOPHIA TALEGHANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295364545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA TALEGHANI MD

Provider Business Mailing Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7419
Country	:	US
Telephone Number	:	310-825-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1548
Country	:	US
Telephone Number	:	310-825-7375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	05/22/2020

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