Provider Demographics
NPI:1053874628
Name:KOOROSH JOSHUA ELIHU, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KOOROSH JOSHUA ELIHU, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOROOSH
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:ELIHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-497-1300
Mailing Address - Street 1:315 N DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1621
Mailing Address - Country:US
Mailing Address - Phone:310-497-1300
Mailing Address - Fax:800-515-1908
Practice Address - Street 1:8905 VENICE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3340
Practice Address - Country:US
Practice Address - Phone:213-340-6505
Practice Address - Fax:800-515-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty