Provider Demographics
NPI:1457361271
Name:ALKOURAINY, KOUSAY ABDULLAH (MD)
Entity Type:Individual
Prefix:
First Name:KOUSAY
Middle Name:ABDULLAH
Last Name:ALKOURAINY
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 1:480 4TH AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-425-2080
Mailing Address - Fax:619-425-8410
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-425-2080
Practice Address - Fax:619-425-8410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39783207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A397830Medicaid
CAA28967Medicare UPIN
CAA39783Medicare ID - Type Unspecified