Provider Demographics
NPI:1588890685
Name:KOUROSH KEYHANI, DO PA
Entity type:Organization
Organization Name:KOUROSH KEYHANI, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-880-8600
Mailing Address - Street 1:3123 BLUE BONNET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2003
Mailing Address - Country:US
Mailing Address - Phone:713-880-8600
Mailing Address - Fax:713-880-8374
Practice Address - Street 1:1631 NORTH LOOP W
Practice Address - Street 2:#610
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1528
Practice Address - Country:US
Practice Address - Phone:713-880-8600
Practice Address - Fax:713-880-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM62252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty