NPIMap

Individual provider Active NPI

Sohail Davoudian, M.D.

  • Internal Medicine Physician
  • Redondo Beach, CA
National Provider Identifier
1255462248
Registry record updated Jan 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A44878 Issued in CA
Practice address
1959 Kingsdale Ave
Redondo Beach, CA 90278-3417
Phone
(310) 214-1000
Fax
(310) 214-8540
NPI assigned
Mar 8, 2007
Last updated
Jan 6, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A44878 CA Primary

Addresses

Primary practice location

1959 Kingsdale Ave
Redondo Beach, CA 90278-3417

Mailing address

1959 Kingsdale Ave
Redondo Beach, CA 90278-3417
Phone (310) 214-1000

Other identifiers 1

IdentifierTypeStateIssuer
GR0059090MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090717000020 CA Practitioner - Internal MedicinePractitioner - Family Practice 7012067069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1959 Kingsdale Ave
Redondo Beach, CA 90278-3417
Phone (310) 214-8500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44878CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Soma Medical Group Internal Medicine CurrentSince Jun 1, 1993 Accepting new patients
Roohbakhsh Maher DPM. Inc Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Providence Health System Southern California Past Accepting new patients

Locations

1959 Kingsdale Ave
Redondo Beach, CA 90278
Phone (310) 214-1000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The EarlwoodTorrance, CA, CCN 055032 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 6, 2020
Oct 6, 2020
Kei-Ai South Bay Healthcare CenterGardena, CA, CCN 555306 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2024
Mar 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Agva, LLC

    dba Kei-Ai South Bay Healthcare Center

    • Skilled Nursing Facility
    • Gardena, CA
    • NPI 1639548449

    Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • The Earlwood, LLC

    dba The Earlwood

    • Skilled Nursing Facility
    • Torrance, CA
    • NPI 1720153620

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231200000000",
    "number": "1255462248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 KINGSDALE AVE",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783417",
            "telephone_number": "310-214-1000",
            "fax_number": "310-214-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 KINGSDALE AVE",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783417",
            "telephone_number": "310-214-1000",
            "fax_number": "310-214-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVOUDIAN",
        "first_name": "SOHAIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2009-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A44878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0059090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

Verify at the official NPI Registry.