Provider Demographics
NPI:1174392120
Name:NOWROOZI, SOHRAB
Entity type:Individual
Prefix:
First Name:SOHRAB
Middle Name:
Last Name:NOWROOZI
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 1:7004 HEBRIDES CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1419
Mailing Address - Country:US
Mailing Address - Phone:818-424-4084
Mailing Address - Fax:
Practice Address - Street 1:7004 HEBRIDES CIR
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1419
Practice Address - Country:US
Practice Address - Phone:818-424-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI423041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice