1194911206 NPI number — WOODMAN MEDICAL & DENTAL CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194911206 NPI number — WOODMAN MEDICAL & DENTAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODMAN MEDICAL & DENTAL CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194911206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8725 WOODMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91331-6560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-891-4455
Provider Business Mailing Address Fax Number:
818-891-5583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8725 WOODMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91331-6560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-891-4455
Provider Business Practice Location Address Fax Number:
818-891-5583
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NOURI
Authorized Official First Name:
JAHANBAKHSH
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D
Authorized Official Telephone Number:
818-891-4455

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A534841 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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