Provider Demographics
NPI:1043358369
Name:HEKMAT, SOHEIL P (MD)
Entity Type:Individual
Prefix:
First Name:SOHEIL
Middle Name:P
Last Name:HEKMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1907
Mailing Address - Country:US
Mailing Address - Phone:310-672-9000
Mailing Address - Fax:310-672-9030
Practice Address - Street 1:511 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1907
Practice Address - Country:US
Practice Address - Phone:310-672-9000
Practice Address - Fax:310-672-9030
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32561207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A325610Medicaid
CAA84365Medicare UPIN