Provider Demographics
NPI:1063468346
Name:KASHANI, HOUMAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOUMAN
Middle Name:M
Last Name:KASHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 49901
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-0901
Mailing Address - Country:US
Mailing Address - Phone:213-622-3100
Mailing Address - Fax:866-867-2392
Practice Address - Street 1:747 WAREHOUSE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1106
Practice Address - Country:US
Practice Address - Phone:213-622-3100
Practice Address - Fax:866-867-2392
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84361207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84361OtherBLUE CROSS
CA00A843610Medicaid
CAWA84361BMedicare Oscar/Certification
CAI14213Medicare UPIN