Healthcare Provider Details

I. General information

NPI: 1194911206
Provider Name (Legal Business Name): WOODMAN MEDICAL & DENTAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 WOODMAN AVE
ARLETA CA
91331-6560
US

IV. Provider business mailing address

8725 WOODMAN AVE
ARLETA CA
91331-6560
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-4455
  • Fax: 818-891-5583
Mailing address:
  • Phone: 818-891-4455
  • Fax: 818-891-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAHANBAKHSH NOURI
Title or Position: M.D
Credential: M.D
Phone: 818-891-4455