Individual
DR. BRIAN THEODORE SOETIKNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
100 STEIN PLZ, LOS ANGELES, CA 90095-4053
(310) 825-3090
(310) 206-5673
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A181412
CA
207WX0107X
Retina Specialist (Ophthalmology) Physician
A181412
CA
Other
Enumeration date
02/16/2015
Last updated
07/01/2025
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