MEDICARE: DR. EMIL SOORANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A37184	CA

General Provider Information

NPI Number	:	1053434472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMIL SOORANI M.D.

Provider Business Mailing Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	SUITE 300
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-453-2212
Fax Number	:	310-453-1043

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	SUITE 300
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-453-2212
Fax Number	:	310-453-1043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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