Active NPI
Behrooz David Soofer, DPM
- Podiatrist
- Los Angeles, CA
National Provider Identifier
1891789798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- E4059
- Practice address
- 10379 Eastborne Ave
Los Angeles, CA 90024-5364 - Phone
- (310) 430-8870
- Fax
- (323) 432-0860
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | E4059 | CA | Primary |
Addresses
Primary practice location
10379 Eastborne Ave
Los Angeles, CA 90024-5364
Mailing address
10379 Eastborne Ave
Los Angeles, CA 90024-5364
Phone (310) 430-8870
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000E40591 | Other | CA | BLUESHIELD |
| E4059 | Other | CA | BLUE CROSS |
| E4059 | Other | LICENSE NUMBER | |
| 000E40592 | Medicaid | CA | |
| 480031462 | Other | CA | MEDICARE RAILROAD |
Other names 1
- Behrooz D Soofer
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4059 | CA | MD | Podiatrist |
| 4059 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700265600000",
"number": "1891789798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10379 EASTBORNE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900245364",
"telephone_number": "310-430-8870",
"fax_number": "323-432-0860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10379 EASTBORNE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900245364",
"telephone_number": "310-430-8870",
"fax_number": "323-432-0860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOOFER",
"first_name": "BEHROOZ",
"middle_name": "DAVID",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2023-11-18",
"certification_date": "2023-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "CA",
"license": "E4059",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUESHIELD",
"identifier": "000E40591",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "E4059",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "E4059",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000E40592",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480031462",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "BEHROOZ",
"last_name": "SOOFER",
"middle_name": "D",
"credential": "DPM",
"code": "5",
"type": "Other Name"
}
]
}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 Nov 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.