Provider Demographics
NPI:1871577106
Name:KOURI, STEPHEN T (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:KOURI
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 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:1720 TERMINO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2104
Practice Address - Country:US
Practice Address - Phone:562-498-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75403207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754031Medicaid
CACV935ZMedicare PIN
CAWG75403CMedicare PIN
CAP00757738Medicare PIN
CAG47031Medicare UPIN
CAWG75403BMedicare PIN
CA00G754031Medicaid
CAWG75403ZMedicare PIN
CAP00812763Medicare PIN