Provider Demographics
NPI:1033469911
Name:KASSEM, NUSHKA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:NUSHKA
Middle Name:
Last Name:KASSEM
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E 6TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1251
Mailing Address - Country:US
Mailing Address - Phone:213-327-4586
Mailing Address - Fax:
Practice Address - Street 1:1375 E 6TH ST STE 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1251
Practice Address - Country:US
Practice Address - Phone:213-327-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-13363171100000X
CAND-210175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist