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Organization
VICLINIC PC
Active
Organization
VICLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOORENA KHOJASTEH MD (OWNER/PHYSICIAN)
(914) 610-0950
Entity
Organization
Contact information
Practice address
3908 KENSINGTON AVE, PHILADELPHIA, PA 19124-4400
(914) 610-0950
Mailing address
345 LAUREL LN, HAVERFORD, PA 19041-1930
(914) 610-0950
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
06/20/2018
Last updated
06/20/2018
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