Provider Demographics
NPI:1235576968
Name:KASHA, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:KASHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 WAVERLY DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2052
Mailing Address - Country:US
Mailing Address - Phone:323-667-0061
Mailing Address - Fax:
Practice Address - Street 1:3016 WAVERLY DR
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2052
Practice Address - Country:US
Practice Address - Phone:323-667-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3534213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery