Individual
KOUROSH NOURISAMIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4241 LONG BEACH BLVD, LONG BEACH, CA 90807-2003
(562) 912-2507
(484) 918-2507
Mailing address
4241 LONG BEACH BLVD, LONG BEACH, CA 90807-2003
(562) 912-2507
(484) 916-2507
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A81741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A817410
BLUE SHIELD
—
05
—
00A817410
—
CA
Enumeration date
11/18/2005
Last updated
03/25/2015
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