Provider Demographics
NPI:1740711944
Name:GHIAM, MICHAEL KOUROSH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KOUROSH
Last Name:GHIAM
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 1:23318 PARK COLOMBO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2810
Mailing Address - Country:US
Mailing Address - Phone:818-625-8729
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2020
Practice Address - Country:US
Practice Address - Phone:818-625-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184572207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology