Provider Demographics
NPI:1821532367
Name:SOOFERI & SOOFERI A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SOOFERI & SOOFERI A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOFERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-296-2300
Mailing Address - Street 1:5010 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1800
Mailing Address - Country:US
Mailing Address - Phone:323-296-2300
Mailing Address - Fax:323-290-4072
Practice Address - Street 1:5010 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1800
Practice Address - Country:US
Practice Address - Phone:323-296-2300
Practice Address - Fax:323-290-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57377261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental