Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DR60648241 | WA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DR60648241 | WA |
NPI | 1598125643 |
---|---|
Provider Name | Amir Nojoumi |
First Address | Fresno, CA 93701-2302 |
Second Address | Fresno, CA 93701-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2016 |
Last Update Date | 30/05/2019 |