Healthcare Provider Details

I. General information

NPI: 1679973747
Provider Name (Legal Business Name): SOHEIL GOEL DDS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38532
License Number StateCA

VIII. Authorized Official

Name: SOHEIL GOEL
Title or Position: OWNER
Credential: DDS
Phone: 818-907-9900