Healthcare Provider Details

I. General information

NPI: 1265543920
Provider Name (Legal Business Name): ANDREI SOUCHITSKI SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E WASHINGTON BLVD
LOS ANGELES CA
90015-3723
US

IV. Provider business mailing address

514 E WASHINGTON BLVD
LOS ANGELES CA
90015-3723
US

V. Phone/Fax

Practice location:
  • Phone: 213-749-3934
  • Fax: 213-749-0994
Mailing address:
  • Phone: 213-749-3934
  • Fax: 213-749-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43249
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: