Provider Demographics
NPI:1932324100
Name:NOURI, FOUAD MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:MOHAMMED
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 1:10732 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4933
Mailing Address - Country:US
Mailing Address - Phone:310-559-7311
Mailing Address - Fax:310-559-7325
Practice Address - Street 1:10732 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4933
Practice Address - Country:US
Practice Address - Phone:310-559-7311
Practice Address - Fax:310-559-7325
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064212208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70992Medicare UPIN
CAA64212AMedicare PIN