MEDICARE: ASHEEM NOUDJOUMI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50662	CA

General Provider Information

NPI Number	:	1164692166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHEEM NOUDJOUMI DDS

Provider Business Mailing Address
First Line	:	4535 SAN FELICIANO DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5037
Country	:	US
Telephone Number	:	818-594-5944
Fax Number	:

Provider Business Practice Location Address
First Line	:	4535 SAN FELICIANO DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5037
Country	:	US
Telephone Number	:	818-594-5944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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