Healthcare Provider Details

I. General information

NPI: 1235583287
Provider Name (Legal Business Name): SOROUSH FARNOOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E CESAR E CHAVEZ AVE STE 2500
LOS ANGELES CA
90033-2434
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE STE 2500
LOS ANGELES CA
90033-2434
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-6731
  • Fax: 323-268-6738
Mailing address:
  • Phone: 323-268-6731
  • Fax: 323-268-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA171997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: