Provider Demographics
NPI:1366501629
Name:NOURI, JAHANBAKHSH (MD)
Entity Type:Individual
Prefix:MR
First Name:JAHANBAKHSH
Middle Name:
Last Name:NOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331
Mailing Address - Country:US
Mailing Address - Phone:818-891-4455
Mailing Address - Fax:818-891-5583
Practice Address - Street 1:8725 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6560
Practice Address - Country:US
Practice Address - Phone:818-891-4455
Practice Address - Fax:818-891-5583
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53484208D00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534841Medicaid
CA00A534841Medicaid