Provider Demographics
NPI:1407939440
Name:ASHOORI, HOOSHANG (DC)
Entity Type:Individual
Prefix:
First Name:HOOSHANG
Middle Name:
Last Name:ASHOORI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260214
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0214
Mailing Address - Country:US
Mailing Address - Phone:818-344-3888
Mailing Address - Fax:818-344-3899
Practice Address - Street 1:6650 RESEDA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5340
Practice Address - Country:US
Practice Address - Phone:818-344-3888
Practice Address - Fax:818-344-3899
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05192868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00DC250010Medicaid
CADC25001Medicare ID - Type Unspecified