# KOUROSH ALEXANDER DASTGHEIB, M.D., INC

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

## Provider details

- **NPI number:** 1922205202
- **Authorized official:** HEATHER RENEE ROWLAND (BILLING/CREDENTIALING MANAGER)
- **Authorized official phone:** (818) 356-4500

## Contact information

- **Practice address:** 12665 GARDEN GROVE BLVD, STE 301, GARDEN GROVE, CA 92843-1917
- **Practice address phone:** (949) 652-6966
- **Practice address fax:** (714) 422-0960
- **Mailing address:** 12665 GARDEN GROVE BLVD STE 301, GARDEN GROVE, CA 92843-1917
- **Mailing address phone:** (949) 652-6966
- **Mailing address fax:** (714) 422-0960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2007
- **Last updated:** 07/17/2024