MEDICARE: ELGRICHI HAROUNI DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366086191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELGRICHI HAROUNI DENTAL CORP

Provider Business Mailing Address
First Line	:	15111 WHITTIER BLVD STE 101-A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	310-903-2658
Fax Number	:

Provider Business Practice Location Address
First Line	:	15111 WHITTIER BLVD STE 101-A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	310-903-2658
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. NIMA HAROUNI
Credential	:	DDS
Telephone Number	:	310-903-2658

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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