Provider Demographics
NPI:1588400733
Name:CLEAN HEART CARDIOLOGY PC
Entity type:Organization
Organization Name:CLEAN HEART CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-713-2323
Mailing Address - Street 1:1800 WESTERN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1354
Mailing Address - Country:US
Mailing Address - Phone:909-713-2323
Mailing Address - Fax:909-340-4421
Practice Address - Street 1:1800 WESTERN AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1354
Practice Address - Country:US
Practice Address - Phone:909-713-2323
Practice Address - Fax:909-340-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty