Provider Demographics
NPI:1851694988
Name:SOUFERZADEH, BEHZAD (DO)
Entity Type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:SOUFERZADEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BEHZAD
Other - Middle Name:
Other - Last Name:SOUFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5000 VAN NUYS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1717
Mailing Address - Country:US
Mailing Address - Phone:818-572-1490
Mailing Address - Fax:818-572-1491
Practice Address - Street 1:5000 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1717
Practice Address - Country:US
Practice Address - Phone:818-572-1490
Practice Address - Fax:818-572-1491
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine