Manoochehr Koukhab, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

C42744 Issued in CA

Practice address

3513 Whittier Blvd
Los Angeles, CA 90023-1709

Phone

(323) 262-1814

Fax

(323) 262-1699

NPI assigned

Feb 15, 2007

Last updated

Jun 24, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Functional Restoration Medical Center, Inc,

  dba Roxbury Pet- CT Imaging

  • Radiology Clinic/Center
  • Beverly Hills, CA
  • NPI 1942301353
  NPD (past)
• United Medical Imaging Healthcare, Inc.

  dba United Medical Imaging of Brea

  • Radiology Clinic/Center
  • Brea, CA
  • NPI 1326138686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1770626905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 OAKRIDGE TER",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913023203",
            "telephone_number": "818-224-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3513 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900231709",
            "telephone_number": "323-262-1814",
            "fax_number": "323-262-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUKHAB",
        "first_name": "MANOOCHEHR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C42744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "C42744",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan H. Kotton, M.D.
• Aditi Pravin Kotyankar
• Aretha Kou, DO
• Sarah Kouchak-Eftekhar
• Haleh Kouchmeshki, PSYD
• Kristyan M Kouri
• Philip Dimitrios Kouros, M.D.
• Kourosh Harounian DPM Inc
• Kourosh Kevin Daneshgar, M.D., Inc.
• Kourosh Michael Beral DDS Inc

• Diagnostic Radiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.