Provider Demographics
NPI:1417964362
Name:SOROUDI, MEYER MEHDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEYER
Middle Name:MEHDI
Last Name:SOROUDI
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 1:16161 GOTHARD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3603
Mailing Address - Country:US
Mailing Address - Phone:714-843-6255
Mailing Address - Fax:714-282-7031
Practice Address - Street 1:16161 GOTHARD ST
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3603
Practice Address - Country:US
Practice Address - Phone:714-843-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA263012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD37926Medicare UPIN