Basic Information
| Provider Information | |||||||||
| NPI: | 1760137335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEAN WILLIAM KALOOSTIAN MD INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 S SAN RAFAEL AVE | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911051542 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4445 MAGNOLIA AVE | ||||||||
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| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925014199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517883000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2022 | ||||||||
| LastUpdateDate: | 02/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | KALOOSTIAN | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8188360978 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.