MEDICARE: KOUROSH YOUSEFZADEH 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
1	122300000X	Dentist	59404	CA

General Provider Information

NPI Number	:	1861801243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOUROSH YOUSEFZADEH DDS

Provider Business Mailing Address
First Line	:	523 W 6TH ST STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-1228
Country	:	US
Telephone Number	:	213-627-5895
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 W 6TH ST STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-1228
Country	:	US
Telephone Number	:	213-627-5895
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	KOUROSH YOUSEFZADEH
Credential	:	DDS
Telephone Number	:	213-627-5895

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	01/09/2020

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