MEDICARE: HOWARD L SOFEN, MD A MEDICAL CORPORATION

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	207N00000X	Dermatology Physician	G47799	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W12100	OTHER	CA	MEDICARE-PTAN

General Provider Information

NPI Number	:	1588723571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD L SOFEN, MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	#114
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-337-7171
Fax Number	:	310-337-1081

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	#114
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-337-7171
Fax Number	:	310-337-1081

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HOWARD SOFEN
Credential	:	MD
Telephone Number	:	310-337-7171

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	04/01/2013

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Directions to “HOWARD L SOFEN, MD A MEDICAL CORPORATION ” Practice Location

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