MEDICARE: DR. NATHAN A NOURIAN 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
1	122300000X	Dentist	DDS105373	CA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DDS105373	CA

General Provider Information

NPI Number	:	1679175871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN A NOURIAN DDS

Provider Business Mailing Address
First Line	:	8424 VAN NUYS BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-893-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8424 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-986-7531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	08/11/2023

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