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General NPI Number Information
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NPI Number | 1922205202
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Entity Type | Organization
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Legal Business Name | KOUROSH ALEXANDER DASTGHEIB, M.D., INC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/17/2024
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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 | 949-652-6966
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Fax | 714-422-0960
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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 | 949-652-6966
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Fax | 714-422-0960
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MANAGER
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Name | HEATHER RENEE ROWLAND
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Credential |
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Telephone | 818-356-4500
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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 |
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License Number State |
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