Provider Demographics
NPI:1235583287
Name:FARNOOSH, SOROUSH (MD)
Entity Type:Individual
Prefix:
First Name:SOROUSH
Middle Name:
Last Name:FARNOOSH
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 1:1700 E CESAR E CHAVEZ AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2434
Mailing Address - Country:US
Mailing Address - Phone:323-268-6731
Mailing Address - Fax:323-268-6738
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:323-268-6731
Practice Address - Fax:323-268-6738
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171997207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty