Healthcare Provider Details

I. General information

NPI: 1669867982
Provider Name (Legal Business Name): HAMID NOURI DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 SUNLAND BLVD
SUN VALLEY CA
91352-2833
US

IV. Provider business mailing address

8805 SUNLAND BLVD
SUN VALLEY CA
91352-2833
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-5243
  • Fax: 818-767-1902
Mailing address:
  • Phone: 818-767-5243
  • Fax: 818-767-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39689
License Number StateCA

VIII. Authorized Official

Name: HAMID NOURI
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 818-767-5243