Healthcare Provider Details

I. General information

NPI: 1447440482
Provider Name (Legal Business Name): SOROUR D.M.D, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 HAWTHORNE BLVD
HAWTHORNE CA
90250-5805
US

IV. Provider business mailing address

13340 HAWTHORNE BLVD
HAWTHORNE CA
90250-5805
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-8004
  • Fax: 310-973-8005
Mailing address:
  • Phone: 310-973-8004
  • Fax: 310-973-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number54394
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54393
License Number StateCA

VIII. Authorized Official

Name: DR. THARWAT SOROUR
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 310-973-8004