Provider Demographics
NPI:1164549689
Name:MOHAMMADI, KOUROSH (MD)
Entity Type:Individual
Prefix:
First Name:KOUROSH
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 CASS ST
Mailing Address - Street 2:710
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2074
Mailing Address - Country:US
Mailing Address - Phone:858-336-9102
Mailing Address - Fax:
Practice Address - Street 1:4944 CASS ST
Practice Address - Street 2:710
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2074
Practice Address - Country:US
Practice Address - Phone:858-336-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95368207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology