Provider Demographics
NPI:1861801243
Name:KOUROSH YOUSEFZADEH DDS
Entity type:Organization
Organization Name:KOUROSH YOUSEFZADEH DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-627-5895
Mailing Address - Street 1:523 W 6TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1228
Mailing Address - Country:US
Mailing Address - Phone:213-627-5895
Mailing Address - Fax:
Practice Address - Street 1:523 W 6TH ST STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1228
Practice Address - Country:US
Practice Address - Phone:213-627-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty