Provider Demographics
NPI:1578743647
Name:SOHAIL SAM MAHBOUBIAN, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SOHAIL SAM MAHBOUBIAN, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:MAHBOUBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-379-9991
Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:SUITE #415
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2403
Mailing Address - Country:US
Mailing Address - Phone:818-379-9991
Mailing Address - Fax:818-995-0208
Practice Address - Street 1:16133 VENTURA BLVD STE 415
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-379-9991
Practice Address - Fax:818-995-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA069412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty