Provider Demographics
NPI:1275619736
Name:DANESHGAR, KOUROSH K (MD)
Entity Type:Individual
Prefix:
First Name:KOUROSH
Middle Name:K
Last Name:DANESHGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:DANESHGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8679 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2315
Mailing Address - Country:US
Mailing Address - Phone:310-553-1200
Mailing Address - Fax:310-553-1216
Practice Address - Street 1:8679 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2315
Practice Address - Country:US
Practice Address - Phone:310-553-1200
Practice Address - Fax:310-553-1216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology