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General NPI Number Information
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NPI Number | 1184774374
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Entity Type | Individual
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Provider Name | KOUROSH MOAZEMI MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 3901 LONE TREE WAY
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City | ANTIOCH
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State | CA
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Zip | 94509-6200
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Country | US
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Telephone | 925-432-3318
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 925-432-3318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036105401
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A78865
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A78865
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License Number State | CA
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