MEDICARE: DR. MATTHEW NORMAN KOURY M.D.

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	2084P0800X	Psychiatry Physician	A91131	CA

General Provider Information

NPI Number	:	1376633735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW NORMAN KOURY M.D.

Provider Business Mailing Address
First Line	:	1223 WILSHIRE BLVD # 767
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5406
Country	:	US
Telephone Number	:	617-504-7826
Fax Number	:	310-825-0340

Provider Business Practice Location Address
First Line	:	760 WESTWOOD PLZ # C8-222
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5055
Country	:	US
Telephone Number	:	310-825-9283
Fax Number	:	310-825-0340

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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