Healthcare Provider Details

I. General information

NPI: 1134039936
Provider Name (Legal Business Name): GHADOUSHI AND NOURIAN DENTAL OF LOS ANGELES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 S WESTERN AVE
LOS ANGELES CA
90006-4233
US

IV. Provider business mailing address

14248 HAWTHORNE BLVD
HAWTHORNE CA
90250-7008
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-8767
  • Fax:
Mailing address:
  • Phone: 310-482-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TYLER GHADOUSHI
Title or Position: OWNER
Credential: DDS
Phone: 949-537-1255