MEDICARE: S. SOLEIMANIAN DDS 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1326505397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. SOLEIMANIAN DDS INC

Provider Business Mailing Address
First Line	:	1620 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5604
Country	:	US
Telephone Number	:	310-475-5598
Fax Number	:	310-475-1970

Provider Business Practice Location Address
First Line	:	1620 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5604
Country	:	US
Telephone Number	:	310-475-5598
Fax Number	:

Authorized Official
Title or Position	:	COORDINATOR
Name	:	MRS. FAY SOLOMON
Credential	:
Telephone Number	:	310-475-5598

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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