Provider Demographics
NPI:1760540769
Name:TEHRANI, KOUROSH SOLIMAN (PT)
Entity Type:Individual
Prefix:MR
First Name:KOUROSH
Middle Name:SOLIMAN
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-550-8585
Mailing Address - Fax:310-860-0506
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:102
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-550-8585
Practice Address - Fax:310-860-0506
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06500ZOtherBLUE SHIELD OF CALIFORNIA
CA675803OtherUNITED HEALTH CARE
CAWPT18513AMedicare ID - Type Unspecified