Provider Demographics
NPI:1992366165
Name:KAMALI AZAD, NOURA (DDS)
Entity type:Individual
Prefix:DR
First Name:NOURA
Middle Name:
Last Name:KAMALI AZAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S CLARK DR APT 204
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3276
Mailing Address - Country:US
Mailing Address - Phone:917-579-8533
Mailing Address - Fax:
Practice Address - Street 1:118 S CLARK DR APT 204
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-3276
Practice Address - Country:US
Practice Address - Phone:917-579-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist