Healthcare Provider Details

I. General information

NPI: 1871006031
Provider Name (Legal Business Name): DOHENY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 501
LOS ANGELES CA
90067-2008
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 501
LOS ANGELES CA
90067-2008
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-6886
  • Fax:
Mailing address:
  • Phone: 310-550-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA103147
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA103147
License Number StateCA

VIII. Authorized Official

Name: SOHEIL SAUL LAHIJANI
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 310-550-6886