Healthcare Provider Details

I. General information

NPI: 1851428411
Provider Name (Legal Business Name): JACK HAROUNI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 N MAGNOLIA AVE STE 103
EL CAJON CA
92020-3611
US

IV. Provider business mailing address

480 N MAGNOLIA AVE STE 103
EL CAJON CA
92020-3611
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-6355
  • Fax:
Mailing address:
  • Phone: 619-444-6355
  • Fax: 916-484-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: