Provider Demographics
NPI:1770725897
Name:KOUROSH KHAMOOSHIAN MD, PC
Entity type:Organization
Organization Name:KOUROSH KHAMOOSHIAN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMOOSHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-603-6576
Mailing Address - Street 1:14677 VIA BETTONA
Mailing Address - Street 2:SUITE 110, PMB 136
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4809
Mailing Address - Country:US
Mailing Address - Phone:858-367-8601
Mailing Address - Fax:858-408-3844
Practice Address - Street 1:555 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3048
Practice Address - Country:US
Practice Address - Phone:760-739-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110901282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD4794OtherRESIDENCY NUMBER
CAD4794OtherRESIDENCY NUMBER