Active NPI
Sohrab Imani, D.D.S.
- Endodontics
- Los Angeles, CA
National Provider Identifier
1073702833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 53073
- Practice address
- 2990 S Sepulveda Blvd Ste 304
Los Angeles, CA 90064-3996 - Phone
- (310) 400-0337
- NPI assigned
- Oct 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 53073 | CA | Primary |
Addresses
Primary practice location
2990 S Sepulveda Blvd Ste 304
Los Angeles, CA 90064-3996
Mailing address
PO Box 641935
Los Angeles, CA 90064-6935
Phone (310) 400-0337
Other practice location 1
12115 San Vicente Blvd Unit 112
Los Angeles, CA 90049-4929
Phone (310) 400-0337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53073 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1073702833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 641935",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900646935",
"telephone_number": "310-400-0337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2990 S SEPULVEDA BLVD STE 304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900643996",
"telephone_number": "310-400-0337"
}
],
"practiceLocations": [
{
"address_1": "12115 San Vicente Blvd Unit 112",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900494929",
"country_code": "US",
"telephone_number": "310-400-0337",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IMANI",
"first_name": "SOHRAB",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-17",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "53073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.