MEDICARE: MEYER M. SOROUDI M.D. INC.

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	2085R0202X	Diagnostic Radiology Physician	A26301	CA

General Provider Information

NPI Number	:	1053561597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEYER M. SOROUDI M.D. INC.

Provider Business Mailing Address
First Line	:	106 PARK AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1013
Country	:	US
Telephone Number	:	714-323-2264
Fax Number	:	949-566-0070

Provider Business Practice Location Address
First Line	:	106 PARK AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1013
Country	:	US
Telephone Number	:	714-323-2264
Fax Number	:	949-566-0070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEYER M SOROUDI
Credential	:	M.D.
Telephone Number	:	714-323-2264

Provider Enumeration Date	:	09/21/2008
Last Update Date	:	09/21/2008

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