Healthcare Provider Details

I. General information

NPI: 1609172097
Provider Name (Legal Business Name): HOMAYOUN POURNIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 CANTRELL RD STE 100
LITTLE ROCK AR
72223-1604
US

IV. Provider business mailing address

12600 CANTRELL RD STE 100
LITTLE ROCK AR
72223-1604
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1044
  • Fax:
Mailing address:
  • Phone: 501-224-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2018-01729
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT2026-068
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberA146226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: