Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 53073 | CA |
NPI | 1073702833 |
---|---|
Provider Name | Dr. Sohrab Imani |
First Address | Los Angeles, CA 90064-6935 |
Second Address | Los Angeles, CA 90064-3996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/03/2018 |