Provider Demographics
NPI:1174043764
Name:POUR, HAMID
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:POUR
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 1:51 SERENITY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1511
Mailing Address - Country:US
Mailing Address - Phone:310-483-1939
Mailing Address - Fax:
Practice Address - Street 1:51 SERENITY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1511
Practice Address - Country:US
Practice Address - Phone:310-483-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014481223X0400X, 122300000X
NV70411223X0400X
NVS3-3561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist