Healthcare Provider Details

I. General information

NPI: 1114018173
Provider Name (Legal Business Name): VIPAL SONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD SUITE #325
HUNTINGTON BEACH CA
92647-6818
US

IV. Provider business mailing address

17742 BEACH BLVD SUITE #325
HUNTINGTON BEACH CA
92647-6818
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-0770
  • Fax: 714-848-6643
Mailing address:
  • Phone: 714-848-0770
  • Fax: 714-848-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA75677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA75677
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA75677
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA75677
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA75677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: