Provider Demographics
NPI:1215149026
Name:SOHAN L. DUA M.D.
Entity type:Organization
Organization Name:SOHAN L. DUA M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-886-7300
Mailing Address - Street 1:8349 RESEDA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4622
Mailing Address - Country:US
Mailing Address - Phone:818-886-5827
Mailing Address - Fax:818-775-9351
Practice Address - Street 1:8349 RESEDA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4622
Practice Address - Country:US
Practice Address - Phone:818-886-5827
Practice Address - Fax:818-775-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0041970Medicaid
CAGR0041970Medicaid
W4724Medicare PIN