=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194410076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEIMA SOBHI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2023
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2625 DILLARD LOOP STE A
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70607-7721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-901-7146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5355 SOUTHPARK DR APT 3107
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70607-6376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-999-3491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7717
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------