KIANOUSH KENNETH SOOFI DO
NPI 1063114759
Student in an Organized Health Care Education/Training Program in Riverside, CA

Q: What is Kianoush Soofi's NPI number?

The NPI number for Kianoush Soofi is 1063114759. It was assigned to this individual provider in the NPPES registry on March 20, 2023.

Q: What is Kianoush Soofi's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kianoush Soofi was last updated on March 20, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 20, 2023PECOS Enrolled

4445 MAGNOLIA AVE, RIVERSIDE, CA 92501(951) 788-3000 Get Directions Write a Review

NPPES record last updated: March 20, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Kianoush Kenneth Soofi Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIANOUSH KENNETH SOOFI DO (NPI 1063114759) is an individual student in an organized health care education/training program in Riverside, California and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063114759

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameKIANOUSH KENNETH SOOFICredential: DO

Location Address4445 MAGNOLIA AVERiverside, CA 92501-4135

Mailing Address43 Via BandadaRancho Santa Margarita, CA 92688-3434

Phone(951) 788-3000

Sole ProprietorNo

Enumeration DateMarch 20, 2023

NPPES CertifiedMarch 18, 2023

✔ NPI 1063114759 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4445 MAGNOLIA AVE, Riverside, CA 92501

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kianoush Kenneth Soofi Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.