Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | A119458 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A119458 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A119458 | CA |
NPI | 1780902536 |
---|---|
Provider Name | Dr. Soroush Zaghi |
First Address | Tarzana, CA 91356 |
Second Address | Los Angeles, CA 90024-3906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 09/04/2017 |