Provider Demographics
NPI:1609964311
Name:JOUSHANPOOSH, HAMID (DC)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:JOUSHANPOOSH
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 1:1066 SARATOGA AVE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3432
Mailing Address - Country:US
Mailing Address - Phone:408-373-2220
Mailing Address - Fax:510-791-1923
Practice Address - Street 1:1860 MOWRY AVE 201
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:408-373-2220
Practice Address - Fax:510-791-1923
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor