Provider Demographics
NPI:1275714982
Name:KOUSAY A. AL-KOURAINY, M.D.
Entity Type:Organization
Organization Name:KOUSAY A. AL-KOURAINY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-425-2080
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-425-2080
Mailing Address - Fax:619-425-8410
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-425-2080
Practice Address - Fax:619-425-8410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOUSAY A. AL-KOURAINY, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAB65972F291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB65972FOtherMEDI-CAL LAB