MEDICARE: KOUROSH TAHMASEBI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0239160	CA

General Provider Information

NPI Number	:	1043374630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOUROSH TAHMASEBI

Provider Business Mailing Address
First Line	:	6280 JACKSON DR STE 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3436
Country	:	US
Telephone Number	:	619-667-3330
Fax Number	:	619-667-3337

Provider Business Practice Location Address
First Line	:	6280 JACKSON DR STE 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3436
Country	:	US
Telephone Number	:	619-667-3330
Fax Number	:	619-667-3337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/23/2008

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Directions to “ KOUROSH TAHMASEBI ” Practice Location

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