Provider Demographics
NPI:1023503620
Name:HAROUNI, NIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:HAROUNI
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 1:119 GROVERTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-3732
Mailing Address - Country:US
Mailing Address - Phone:310-903-2658
Mailing Address - Fax:
Practice Address - Street 1:11344 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2807
Practice Address - Country:US
Practice Address - Phone:323-777-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist