Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A146226 | CA |
Y | 208200000X | Surgeon | 2018-01729 | NC |
Y | 208600000X | Surgeon | 2018-01729 | NC |
NPI | 1609172097 |
---|---|
Provider Name | Homayoun Pournik |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1609172097 | (05) | NC |
19WQU | BCBS OF NC (01) | NC |
NN3172A | MEDICARE (01) | NC |