Provider Demographics
NPI:1104214113
Name:KASRA NAVABI MD
Entity Type:Organization
Organization Name:KASRA NAVABI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-576-9944
Mailing Address - Street 1:3217 N VERDUGO RD
Mailing Address - Street 2:#2
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1672
Mailing Address - Country:US
Mailing Address - Phone:818-550-0702
Mailing Address - Fax:818-550-0705
Practice Address - Street 1:3217 N VERDUGO RD
Practice Address - Street 2:#2
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1672
Practice Address - Country:US
Practice Address - Phone:818-550-0702
Practice Address - Fax:818-550-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA116768261Q00000X
NMMD2012-0589261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA116768OtherMEDICAL BOARD OF CALIFORNIA
NMMD2012-0589OtherNEW MEXICO MEDICAL BOARD