Provider Demographics
NPI:1588723571
Name:HOWARD L SOFEN, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:HOWARD L SOFEN, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-337-7171
Mailing Address - Street 1:8930 S SEPULVEDA BLVD
Mailing Address - Street 2:#114
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-337-7171
Mailing Address - Fax:310-337-1081
Practice Address - Street 1:8930 S SEPULVEDA BLVD
Practice Address - Street 2:#114
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-337-7171
Practice Address - Fax:310-337-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47799207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12100OtherMEDICARE-PTAN
A50817Medicare UPIN