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General NPI Number Information
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NPI Number | 1770725897
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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 | 04/03/2009
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 555 E VALLEY PKWY
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City | ESCONDIDO
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State | CA
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Zip | 92025-3048
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Country | US
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Telephone | 760-739-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 14677 VIA BETTONA SUITE 110, PMB 136
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City | SAN DIEGO
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State | CA
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Zip | 92127-4809
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Country | US
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Telephone | 858-367-8601
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Fax | 858-408-3844
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Authorized Official
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Title or Position | INTERNAL MEDICINE ATTENDING
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Name | KOUROSH KHAMOOSHIAN
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Credential | M.D.
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Telephone | 858-603-6576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A110901
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License Number State | CA
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