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General NPI Number Information
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NPI Number | 1306478466
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Entity Type | Individual
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Provider Name | SORENA KEIHANI MD, MSCI
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Gender | Male
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 3112
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City | MERIDIAN
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State | ID
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Zip | 83642-6352
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Country | US
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Telephone | 208-706-5800
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Fax | 208-706-5810
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | DR.0075039
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 12400317-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 1271357
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License Number State | ID
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