Provider Demographics
NPI:1699101097
Name:DAVID J. SOOMEKH DPM, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DAVID J. SOOMEKH DPM, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOOMEKH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-651-2366
Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4231
Mailing Address - Country:US
Mailing Address - Phone:310-651-2366
Mailing Address - Fax:310-651-2360
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4231
Practice Address - Country:US
Practice Address - Phone:310-651-2366
Practice Address - Fax:310-651-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HM731AMedicare PIN