Viclinic PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VICLINIC PC

Practice address

3908 Kensington Ave
Philadelphia, PA 19124-4400

Phone

(914) 610-0950

NPI assigned

Jun 20, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Soorena Khojasteh, MD

Title

Owner/Physician

Phone

(914) 610-0950

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1619461837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 LAUREL LN",
            "city": "HAVERFORD",
            "state": "PA",
            "postal_code": "190411930",
            "telephone_number": "914-610-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 KENSINGTON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191244400",
            "telephone_number": "914-610-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "KHOJASTEH",
        "authorized_official_first_name": "SOORENA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "914-610-0950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Nicoll Vicioso
• Carey Vickers, L.AC.
• Conor Moran Vickers, MD
• Rosemary Vickers, D.O.
• Jasmine Vickery, MD
• Victor Solon MD PC
• Brett M Victor, M.D.
• Jesse Ryan Victor, M.D.
• Kathleen Ann Victor, RN, MSN, CRNP
• Lourdes Victor

• Family Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.