1245738194 NPI number — SOHEIL LAHIJANI M.D., A MEDICAL CORPORATION

Table of content: (NPI 1245738194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245738194 NPI number — SOHEIL LAHIJANI M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOHEIL LAHIJANI M.D., A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245738194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 CENTURY PARK E STE 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-550-6886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1113 ALTA AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-550-6886
Provider Business Practice Location Address Fax Number:
310-550-6875
Provider Enumeration Date:
01/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LAHIJANI
Authorized Official First Name:
SOHEIL
Authorized Official Middle Name:
SAUL
Authorized Official Title or Position:
MEDICAL DOCTOR/PRESIDENT
Authorized Official Telephone Number:
310-550-6886

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X , with the licence number:  A103147 , 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)

  • Identifier: FM538Y , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB287138 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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