Provider Demographics
NPI:1407251853
Name:NORTHRIDGE FREE CLINIC
Entity Type:Organization
Organization Name:NORTHRIDGE FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAN
Authorized Official - Middle Name:LAL
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-886-7322
Mailing Address - Street 1:8349 RESEDA BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5914
Mailing Address - Country:US
Mailing Address - Phone:818-886-7322
Mailing Address - Fax:818-477-1052
Practice Address - Street 1:8349 RESEDA BLVD STE G
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5914
Practice Address - Country:US
Practice Address - Phone:818-886-7322
Practice Address - Fax:818-477-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25072207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty