Healthcare Provider Details

I. General information

NPI: 1215076799
Provider Name (Legal Business Name): STEPHEN T KOURI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 714-347-1012
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG75403
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN T KOURI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243