Provider Demographics
NPI:1831108679
Name:SOOMEKH, DAVID J (DPM)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:SOOMEKH
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4231
Mailing Address - Country:US
Mailing Address - Phone:310-651-2366
Mailing Address - Fax:310-651-2360
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4231
Practice Address - Country:US
Practice Address - Phone:310-651-2366
Practice Address - Fax:310-651-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2015-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4431213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00110Medicare UPIN
WE4431Medicare PIN