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General NPI Number Information
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NPI Number | 1821532367
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Entity Type | Organization
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Legal Business Name | SOOFERI & SOOFERI A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 5010 S LA BREA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90056-1800
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Country | US
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Telephone | 323-296-2300
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Fax | 323-290-4072
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Provider Business Mailing Address
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Address Line | 5010 S LA BREA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90056-1800
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Country | US
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Telephone | 323-296-2300
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Fax | 323-290-4072
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Authorized Official
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Title or Position | OWNER
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Name | PEDRAM SOOFERI
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Credential | DDS
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Telephone | 323-296-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 57377
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License Number State | CA
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