Healthcare Provider Details

I. General information

NPI: 1992852784
Provider Name (Legal Business Name): SOHEIL LAHIJANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/14/2017
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: 310-550-6875
Mailing address:
  • Phone: 310-550-6886
  • Fax: 310-550-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA103147
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA103147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: