1730382987 NPI number — DR. KOUROSH LANGROUDI GHAFOURPOUR DDS

Table of content: DR. KOUROSH LANGROUDI GHAFOURPOUR DDS (NPI 1730382987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730382987 NPI number — DR. KOUROSH LANGROUDI GHAFOURPOUR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHAFOURPOUR
Provider First Name:
KOUROSH
Provider Middle Name:
LANGROUDI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GHAFOURPOUR
Provider Other First Name:
KRISS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730382987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 BOUNTY DR APT 2408
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSTER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-962-0846
Provider Business Mailing Address Fax Number:
510-962-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 BLOSSOM HILL RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95123-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-224-8266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  44680 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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