Individual
KOUROSH DASTGHEIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12665 GARDEN GROVE BLVD STE 301, GARDEN GROVE, CA 92843-1917
(909) 581-6732
(909) 581-6737
Mailing address
12665 GARDEN GROVE BLVD STE 301, GARDEN GROVE, CA 92843-1917
(714) 636-6282
(714) 422-0960
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A85637
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04531539
ECFMG
—
05
—
100967496
—
PA
Enumeration date
03/24/2006
Last updated
12/04/2018
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