Provider Demographics
NPI:1295868206
Name:KOUROS AZAR MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KOUROS AZAR MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KOUROS
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-373-7073
Mailing Address - Street 1:2100 LYNN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8030
Mailing Address - Country:US
Mailing Address - Phone:805-373-7073
Mailing Address - Fax:805-373-1116
Practice Address - Street 1:2100 LYNN RD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8030
Practice Address - Country:US
Practice Address - Phone:805-373-7073
Practice Address - Fax:805-373-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty