Provider Demographics
NPI:1194911206
Name:WOODMAN MEDICAL & DENTAL CARE INC
Entity type:Organization
Organization Name:WOODMAN MEDICAL & DENTAL CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:JAHANBAKHSH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-891-4455
Mailing Address - Street 1:8725 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6560
Mailing Address - Country:US
Mailing Address - Phone:818-891-4455
Mailing Address - Fax:818-891-5583
Practice Address - Street 1:8725 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6560
Practice Address - Country:US
Practice Address - Phone:818-891-4455
Practice Address - Fax:818-891-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534841Medicaid
CAW14143Medicare UPIN