Healthcare Provider Details

I. General information

NPI: 1770736712
Provider Name (Legal Business Name): DR. SOGHOMONIAN'S MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 JENSEN AVE SUITE #117
SANGER CA
93657-2269
US

IV. Provider business mailing address

2570 JENSEN AVE SUITE #117
SANGER CA
93657-2269
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-2601
  • Fax: 559-261-0596
Mailing address:
  • Phone: 559-875-2601
  • Fax: 559-261-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberA50159
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA50159
License Number StateCA

VIII. Authorized Official

Name: DR. ARA K. SOGHOMONIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-875-2601