Healthcare Provider Details

I. General information

NPI: 1275619736
Provider Name (Legal Business Name): KOUROSH K DANESHGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEVIN DANESHGAR M.D.

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8679 W PICO BLVD
LOS ANGELES CA
90035-2315
US

IV. Provider business mailing address

8679 W PICO BLVD
LOS ANGELES CA
90035-2315
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-1200
  • Fax: 310-553-1216
Mailing address:
  • Phone: 310-553-1200
  • Fax: 310-553-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA64700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: