Healthcare Provider Details

I. General information

NPI: 1366501629
Provider Name (Legal Business Name): JAHANBAKHSH NOURI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
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
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 NumberA53484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: