Provider Demographics
NPI:1023459302
Name:ELIHU, KOOROSH J (MD)
Entity type:Individual
Prefix:DR
First Name:KOOROSH
Middle Name:J
Last Name:ELIHU
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:PO BOX 15742
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-1742
Mailing Address - Country:US
Mailing Address - Phone:310-497-1300
Mailing Address - Fax:
Practice Address - Street 1:8905 VENICE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3340
Practice Address - Country:US
Practice Address - Phone:213-340-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133689207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine