Healthcare Provider Details

I. General information

NPI: 1477023489
Provider Name (Legal Business Name): JACK HAROUNI DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CAMINO DEL RIO S STE 202
SAN DIEGO CA
92108-3520
US

IV. Provider business mailing address

815 LAKE OAK CT
SACRAMENTO CA
95864-6153
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-4990
  • Fax:
Mailing address:
  • Phone: 916-971-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK HAROUNI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 916-204-6625