1942590542 NPI number — SOODEH NILI M.D

Table of content: SOODEH NILI M.D (NPI 1942590542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942590542 NPI number — SOODEH NILI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NILI
Provider First Name:
SOODEH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NILI
Provider Other First Name:
SOODEH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942590542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7345 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WEST HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91307-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-347-2921
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-347-2921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A127432 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)