Provider Demographics
NPI:1902193774
Name:GHANOUNI, SEPAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEPAND
Middle Name:
Last Name:GHANOUNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 ALCOTT ST
Mailing Address - Street 2:#5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3364
Mailing Address - Country:US
Mailing Address - Phone:347-901-2685
Mailing Address - Fax:
Practice Address - Street 1:9055 ALCOTT ST
Practice Address - Street 2:#5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3364
Practice Address - Country:US
Practice Address - Phone:347-901-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA640721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program