Basic Information
| Provider Information | |||||||||
| NPI: | 1326082876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZARNEGAR | ||||||||
| FirstName: | KOUSHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1822 E ROUTE 66 | ||||||||
| Address2: | STE A #275 | ||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917403801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266642183 | ||||||||
| FaxNumber: | 6268526075 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 W MERCED AVE | ||||||||
| Address2: | VIP-WC PET | ||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268139988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 09/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | A52110 | CA | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A521100 | 05 | CA | MEDICAID |