Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 44444 | CA |
NPI | 1063856672 |
---|---|
Provider Name | Peiman Soleymani |
First Address | Beverly Hills, CA 90210-4322 |
Second Address | Beverly Hills, CA 90210-4322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 25/07/2013 |