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NPI Code Detail

MEDICARE: DR. NOUSHIN FANI DDS

MEDICARE: DR. NOUSHIN FANI DDS
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
11223P0300XPeriodontics39149CA

General Provider Information

NPI Number : 1619066974
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NOUSHIN FANI DDS
Provider Business Mailing Address
First Line : 12660 RIVERSIDE DR STE 240
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3431
Country : US
Telephone Number : 818-760-8973
Fax Number : 818-760-8972
Provider Business Practice Location Address
First Line : 12660 RIVERSIDE DR STE 240
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3431
Country : US
Telephone Number : 818-760-8973
Fax Number : 818-760-8972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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Directions to “ DR. NOUSHIN FANI DDS” Practice Location

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