Healthcare Provider Details

I. General information

NPI: 1922083765
Provider Name (Legal Business Name): SOHEILA SOHAEI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W LAUREL ST
INDEPENDENCE KS
67301-3211
US

IV. Provider business mailing address

800 W LAUREL ST PO BOX 845
INDEPENDENCE KS
67301-3211
US

V. Phone/Fax

Practice location:
  • Phone: 620-332-3280
  • Fax: 620-332-3281
Mailing address:
  • Phone: 620-332-3280
  • Fax: 620-332-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0529688
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: