Healthcare Provider Details

I. General information

NPI: 1528039138
Provider Name (Legal Business Name): SOHRAB MOSHIRI DDS PS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
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: 818-222-2588
Mailing address:
  • Phone: 818-518-5020
  • Fax: 818-222-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5739
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4881
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: