Provider Demographics
NPI:1285782664
Name:SORAYA MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:SORAYA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAEID
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-249-6162
Mailing Address - Street 1:2701 FIRESTONE BLVD STE W
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2778
Mailing Address - Country:US
Mailing Address - Phone:323-249-6162
Mailing Address - Fax:323-563-0820
Practice Address - Street 1:2701 FIRESTONE BLVD
Practice Address - Street 2:SUITE W
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2778
Practice Address - Country:US
Practice Address - Phone:323-249-6162
Practice Address - Fax:323-563-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHC1348692085R0202X
CAA46572208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55357ZOtherBLUE CROSS BLUESHIELD
CAA465720OtherHMO I.D.
CA00A465720OtherPPO I.D
CAGR0080040Medicaid
CAGR0080041Medicaid
CAW14232AMedicare ID - Type UnspecifiedGROUP I.D. NORWALK
CAW14232Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0080041Medicaid