Provider Demographics
NPI:1114371424
Name:NOORVASH, JAHANGIR
Entity Type:Individual
Prefix:
First Name:JAHANGIR
Middle Name:
Last Name:NOORVASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2004
Mailing Address - Country:US
Mailing Address - Phone:310-553-3434
Mailing Address - Fax:310-553-2237
Practice Address - Street 1:2080 CENTURY PARK E STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2004
Practice Address - Country:US
Practice Address - Phone:310-553-3434
Practice Address - Fax:310-553-2237
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist