Healthcare Provider Details

I. General information

NPI: 1780227157
Provider Name (Legal Business Name): DR SAM HAROUNI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S BEVERLY DR STE 160B
BEVERLY HILLS CA
90212-4811
US

IV. Provider business mailing address

350 S BEVERLY DR STE 160B
BEVERLY HILLS CA
90212-4811
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-6461
  • Fax:
Mailing address:
  • Phone: 310-927-6461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMAN HAROUNI
Title or Position: PRESIDENT
Credential:
Phone: 310-927-6461