Provider Demographics
NPI:1982412540
Name:YOUNAN, SAMIR
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:YOUNAN
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 1:9575 RESEDA BLVD APT 123
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2366
Mailing Address - Country:US
Mailing Address - Phone:818-671-8282
Mailing Address - Fax:818-671-8282
Practice Address - Street 1:21729 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2618
Practice Address - Country:US
Practice Address - Phone:818-898-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist