Provider Demographics
NPI:1326082876
Name:ZARNEGAR, KOUSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KOUSHA
Middle Name:
Last Name:ZARNEGAR
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 1:1822 E ROUTE 66
Mailing Address - Street 2:STE A #275
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3801
Mailing Address - Country:US
Mailing Address - Phone:626-664-2183
Mailing Address - Fax:626-852-6075
Practice Address - Street 1:1401 W MERCED AVE
Practice Address - Street 2:VIP-WC PET
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3401
Practice Address - Country:US
Practice Address - Phone:626-813-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52110207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521100Medicaid
CAG45709Medicare UPIN