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General NPI Number Information
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NPI Number | 1578523593
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Entity Type | Individual
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Provider Name | KOUROSH DASTGHEIB MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD STE 301
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1917
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Country | US
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Telephone | 909-581-6732
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Fax | 909-581-6737
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Provider Business Mailing Address
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Address Line | 12665 GARDEN GROVE BLVD STE 301
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1917
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Country | US
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Telephone | 714-636-6282
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Fax | 714-422-0960
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A85637
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License Number State | CA
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