| Kh Nourishad Inc | |
|
17703 Vanowen St Reseda CA 91335-5602 | |
| (818) 609-0009 | |
| (818) 609-1158 |
| Full Name | Kh Nourishad Inc |
|---|---|
| Speciality | Dentist |
| Location | 17703 Vanowen St, Reseda, California |
| Authorized Official Name and Position | Khashayar Nourishad (CEO) |
| Authorized Official Contact | 8186090009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kh Nourishad Inc Po Box 17227 Encino CA 91416-7227 Ph: (818) 609-0009 | Kh Nourishad Inc 17703 Vanowen St Reseda CA 91335-5602 Ph: (818) 609-0009 |
| NPI Number | 1689794745 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 11/17/2014 |
| Medicare PECOS PAC ID | 6305079930 |
|---|---|
| Medicare Enrollment ID | O20140505002197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689794745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 38892 (California) | Primary |
| Provider Name | Kass Nourishad |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1104945252 PECOS PAC ID: 7113150749 Enrollment ID: I20140505002210 |
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