Individual provider Active NPI

Soheil Jourabchi, D.D.S

  • General Practice Dentistry
  • Huntington Park, CA
National Provider Identifier
1396857785
Registry record updated Dec 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
42336 Issued in CA
Practice address
5600 Pacific Blvd
Suite#a
Huntington Park, CA 90255-2537
Phone
(323) 585-2100
Fax
(323) 585-6545
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 42336 CA Primary

Addresses

Primary practice location

5600 Pacific Blvd
Suite#a
Huntington Park, CA 90255-2537

Mailing address

5600 Pacific Blvd
Suite#a
Huntington Park, CA 90255-2618
Phone (323) 585-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160520001723 CA Order and Referring Only - DentistPractitioner - Dentist 5890084479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
42336CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1396857785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 PACIFIC BLVD",
            "address_2": "SUITE#A",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552618",
            "telephone_number": "323-585-2100",
            "fax_number": "323-585-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 PACIFIC BLVD",
            "address_2": "SUITE#A",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552537",
            "telephone_number": "323-585-2100",
            "fax_number": "323-585-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOURABCHI",
        "first_name": "SOHEIL",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.