Healthcare Provider Details

I. General information

NPI: 1003510868
Provider Name (Legal Business Name): BAINA JENNY BAROUNI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

937 VERDUGO CIRCLE DR
GLENDALE CA
91206-1535
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax:
Mailing address:
  • Phone: 818-731-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: