Provider Demographics
NPI:1558839779
Name:SOOD KISRA, MD., PC.
Entity Type:Organization
Organization Name:SOOD KISRA, MD., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KISRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-713-2323
Mailing Address - Street 1:10950 ARROW RTE
Mailing Address - Street 2:#1685
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTERN AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1354
Practice Address - Country:US
Practice Address - Phone:909-713-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty