Provider Demographics
NPI:1326092529
Name:SOROUDI, ABRAHAM EBBIE (MD, MS)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:EBBIE
Last Name:SOROUDI
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Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:8900 WILSHIRE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-474-2010
Mailing Address - Fax:310-474-2009
Practice Address - Street 1:8900 WILSHIRE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-474-2010
Practice Address - Fax:310-474-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2024-02-01
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Provider Licenses
StateLicense IDTaxonomies
CAA75978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI39673Medicare UPIN
CAWA75978BMedicare PIN