Provider Demographics
NPI:1114018173
Name:SONI, VIPAL (MD)
Entity Type:Individual
Prefix:
First Name:VIPAL
Middle Name:
Last Name:SONI
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 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE #325
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-848-0770
Mailing Address - Fax:714-848-6643
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE #325
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6818
Practice Address - Country:US
Practice Address - Phone:714-848-0770
Practice Address - Fax:714-848-6643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75677207N00000X, 207NS0135X, 207ND0900X, 207ND0101X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH73542Medicare UPIN