Healthcare Provider Details

I. General information

NPI: 1003378548
Provider Name (Legal Business Name): NIMA KOURANG-BEHESHTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NIMA BEHESHTI

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 LOS PALOS DR STE A
SALINAS CA
93901-3916
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-757-2058
  • Fax:
Mailing address:
  • Phone: 831-242-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A19974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: