Provider Demographics
NPI:1184962284
Name:SOGOL J SAGHARI MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SOGOL J SAGHARI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOGOL
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:SAGHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-493-6649
Mailing Address - Street 1:113 WATERWORKS WAY
Mailing Address - Street 2:235
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3175
Mailing Address - Country:US
Mailing Address - Phone:310-493-6649
Mailing Address - Fax:209-538-6010
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:SUITE 235
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3175
Practice Address - Country:US
Practice Address - Phone:310-493-6649
Practice Address - Fax:209-538-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95790207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty