Healthcare Provider Details

I. General information

NPI: 1417117771
Provider Name (Legal Business Name): SOHA AHMAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE STE 401
LOS ANGELES CA
90027-6086
US

IV. Provider business mailing address

281 E COLORADO BLVD # 751
PASADENA CA
91101-1903
US

V. Phone/Fax

Practice location:
  • Phone: 323-448-0334
  • Fax: 323-336-9319
Mailing address:
  • Phone: 323-448-0334
  • Fax: 323-336-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60640196
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD60640196
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: