Healthcare Provider Details

I. General information

NPI: 1699101097
Provider Name (Legal Business Name): DAVID J. SOOMEKH DPM, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR SUITE 200
BEVERLY HILLS CA
90210-4231
US

IV. Provider business mailing address

450 N ROXBURY DR SUITE 200
BEVERLY HILLS CA
90210-4231
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-2366
  • Fax: 310-651-2360
Mailing address:
  • Phone: 310-651-2366
  • Fax: 310-651-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateCA

VIII. Authorized Official

Name: DAVID J SOOMEKH
Title or Position: OWNER
Credential: D.P.M.
Phone: 310-651-2366