Provider Demographics
NPI:1972608677
Name:KOUROS, PHILIP DIMITRIOS (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DIMITRIOS
Last Name:KOUROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9273 LUBEC ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3052
Mailing Address - Country:US
Mailing Address - Phone:562-622-6575
Mailing Address - Fax:
Practice Address - Street 1:1414 S GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3067
Practice Address - Country:US
Practice Address - Phone:213-743-9000
Practice Address - Fax:213-765-4098
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE96948Medicare UPIN