Provider Demographics
NPI:1073702833
Name:IMANI, SOHRAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOHRAB
Middle Name:
Last Name:IMANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641935
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-6935
Mailing Address - Country:US
Mailing Address - Phone:310-400-0337
Mailing Address - Fax:
Practice Address - Street 1:2990 S SEPULVEDA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3996
Practice Address - Country:US
Practice Address - Phone:310-400-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics