Healthcare Provider Details

I. General information

NPI: 1396964086
Provider Name (Legal Business Name): SOHEIL GOEL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 VENTURA BLVD SUITE # 329
ENCINO CA
91436-2500
US

IV. Provider business mailing address

16101 VENTURA BLVD SUITE # 329
ENCINO CA
91436-2500
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-9900
  • Fax: 818-907-9908
Mailing address:
  • Phone: 818-907-9900
  • Fax: 818-907-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38532
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number38532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: