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NPI Code Detail

MEDICARE: KOUROSH MICHAEL BERAL DDS

MEDICARE: KOUROSH MICHAEL BERAL DDS
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
1122300000XDentist46749CA

General Provider Information

NPI Number : 1063782746
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOUROSH MICHAEL BERAL DDS
Provider Business Mailing Address
First Line : 5701 S HOOVER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-4045
Country : US
Telephone Number : 310-666-5453
Fax Number : 323-541-1494
Provider Business Practice Location Address
First Line : 2204 PARNELL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-2005
Country : US
Telephone Number : 310-666-5453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 01/11/2012

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Directions to “ KOUROSH MICHAEL BERAL DDS” Practice Location

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