Provider Demographics
NPI:1053561597
Name:MEYER M. SOROUDI M.D. INC.
Entity type:Organization
Organization Name:MEYER M. SOROUDI M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOROUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-323-2264
Mailing Address - Street 1:106 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92662-1013
Mailing Address - Country:US
Mailing Address - Phone:714-323-2264
Mailing Address - Fax:949-566-0070
Practice Address - Street 1:106 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92662-1013
Practice Address - Country:US
Practice Address - Phone:714-323-2264
Practice Address - Fax:949-566-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA263012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty