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1225267859 NPI number — SOROYA BACCHUS, MD A PROFESSIONAL MEDICAL CORPORATION

NPI Number: 1225267859
Health Care Provider/Practitioner: SOROYA BACCHUS, MD A PROFESSIONAL MEDICAL CORPORATION

Information about “1225267859” NPI (SOROYA BACCHUS, MD A PROFESSIONAL MEDICAL CORPORATION) exists in 1225267859 in HTML format HTML  |  1225267859 in plain Text format TXT  |  1225267859 in PDF (Portable Document Format) PDF  |  1225267859 in an XML format XML  formats.

NPI Number : 1225267859 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225267859",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SOROYA BACCHUS, MD A PROFESSIONAL MEDICAL CORPORATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6801 PARK TER STE 530B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90045-1543",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-865-2541",
    "MailingAddressFaxNumber": "310-895-2895",
    "FirstLinePracticeLocationAddress": "6801 PARK TER STE 530B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90045-1543",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-865-2541",
    "PracticeLocationAddressFaxNumber": "310-895-2895",
    "EnumerationDate": "07/02/2009",
    "LastUpdateDate": "11/10/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BACCHUS",
    "AuthorizedOfficialFirstName": "SOROYA",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "310-649-2658",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "G74246",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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