MEDICARE: MR. KAVEH SHOKOOHI SOODJANI P.T.

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	225100000X	Physical Therapist	PT 10565	CA

General Provider Information

NPI Number	:	1508929043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAVEH SHOKOOHI SOODJANI P.T.

Provider Business Mailing Address
First Line	:	19136 MERION DR
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1835
Country	:	US
Telephone Number	:	818-567-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	19136 MERION DR
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1835
Country	:	US
Telephone Number	:	818-567-2320
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	11/17/2010

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