=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801335609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOHAIL PARHAM A PROF DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2017
-----------------------------------------------------
Last Update Date | 02/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4955 VAN NUYS BLVD STE 520
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-929-0880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4955 VAN NUYS BLVD STE 520
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-929-0880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SOHAIL PARHAM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 562-929-0880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 38214
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------