Healthcare Provider Details

I. General information

NPI: 1003255852
Provider Name (Legal Business Name): SOHRAB MOSHIRI, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23111 VENTURA BLVD SUITE 202
WOODLAND HILLS CA
91364-1103
US

IV. Provider business mailing address

23111 VENTURA BLVD SUITE 202
WOODLAND HILLS CA
91364-1103
US

V. Phone/Fax

Practice location:
  • Phone: 818-518-5020
  • Fax:
Mailing address:
  • Phone: 818-518-5020
  • Fax: 818-222-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53522
License Number StateCA

VIII. Authorized Official

Name: SOHRAB MOSHIRI
Title or Position: OWNER
Credential: DDS, PS
Phone: 818-518-5020