Provider Demographics
NPI:1487097119
Name:POURMORADY, JONATHAN S
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:POURMORADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE A BOX 164
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4267
Mailing Address - Country:US
Mailing Address - Phone:310-933-3229
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST STE 1015E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5913
Practice Address - Country:US
Practice Address - Phone:310-933-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133753207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology