# KOUROSH KHAMOOSHIAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194079632
- **Authorized official:** DR. KOUROSH KHAMOOSHIAN MD (OWNER / CEO)
- **Authorized official phone:** (858) 373-9616

## Contact information

- **Practice address:** 5565 GROSSMONT CENTER DR STE 444, LA MESA, CA 91942-3020
- **Practice address phone:** (858) 373-9616
- **Practice address fax:** (858) 373-9619
- **Mailing address:** 5565 GROSSMONT CENTER DR STE 444, LA MESA, CA 91942-3020
- **Mailing address phone:** (858) 373-9616
- **Mailing address fax:** (858) 373-9619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | A110901 | CA | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/06/2012
- **Last updated:** 07/01/2025