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General NPI Number Information
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NPI Number | 1194079632
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Entity Type | Organization
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Legal Business Name | KOUROSH KHAMOOSHIAN MD PC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DR STE 444
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 858-373-9616
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Fax | 858-373-9619
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Provider Business Mailing Address
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Address Line | 5565 GROSSMONT CENTER DR STE 444
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 858-373-9616
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Fax | 858-373-9619
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. KOUROSH KHAMOOSHIAN
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Credential | MD
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Telephone | 858-373-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | A110901
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License Number State | CA
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