Provider Demographics
NPI:1669812889
Name:MOGHADAM, SOHEIL S
Entity Type:Individual
Prefix:
First Name:SOHEIL
Middle Name:S
Last Name:MOGHADAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:MOGHADAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4085 ATLANTIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2904
Mailing Address - Country:US
Mailing Address - Phone:562-988-9268
Mailing Address - Fax:562-988-9319
Practice Address - Street 1:4085 ATLANTIC AVE STE D
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-988-9268
Practice Address - Fax:562-988-9319
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7354237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist