Provider Demographics
NPI:1720284607
Name:SOORANI, JAMES M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SOORANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12030 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2618
Mailing Address - Country:US
Mailing Address - Phone:310-391-0473
Mailing Address - Fax:310-391-0474
Practice Address - Street 1:12030 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2618
Practice Address - Country:US
Practice Address - Phone:310-391-0473
Practice Address - Fax:310-391-0474
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28853207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G288530Medicaid
CAA91155Medicare UPIN
CA00G288530Medicaid