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General NPI Number Information
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NPI Number | 1073702833
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Entity Type | Individual
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Provider Name | SOHRAB IMANI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2990 S SEPULVEDA BLVD STE 304
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City | LOS ANGELES
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State | CA
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Zip | 90064-3996
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Country | US
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Telephone | 310-400-0337
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 641935
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City | LOS ANGELES
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State | CA
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Zip | 90064-6935
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Country | US
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Telephone | 310-400-0337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 53073
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License Number State | CA
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