Healthcare Provider Details

I. General information

NPI: 1649473083
Provider Name (Legal Business Name): EDDIE HAROUNI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 807
LOS ANGELES CA
90024-3906
US

IV. Provider business mailing address

10921 WILSHIRE BLVD STE 807
LOS ANGELES CA
90024-3906
US

V. Phone/Fax

Practice location:
  • Phone: 310-209-5050
  • Fax: 310-209-5550
Mailing address:
  • Phone: 310-209-5050
  • Fax: 310-209-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number38194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: