Provider Demographics
NPI:1407556947
Name:KOOROSH JOSHUA ELIHU, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KOOROSH JOSHUA ELIHU, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KOOROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-642-6455
Mailing Address - Street 1:325 N MAPLE DR UNIT 15742
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-5586
Mailing Address - Country:US
Mailing Address - Phone:323-642-6455
Mailing Address - Fax:
Practice Address - Street 1:17264 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5628
Practice Address - Country:US
Practice Address - Phone:323-642-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOOROSH JOSHUA ELIHU, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty