Healthcare Provider Details

I. General information

NPI: 1841502663
Provider Name (Legal Business Name): KOUROSH KALIMI YOUSEFZADEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 W CENTINELA AVE APT 204
LOS ANGELES CA
90045-8800
US

IV. Provider business mailing address

5780 W CENTINELA AVE APT 204
LOS ANGELES CA
90045-8800
US

V. Phone/Fax

Practice location:
  • Phone: 516-244-0477
  • Fax:
Mailing address:
  • Phone: 516-244-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: