Provider Demographics
NPI:1316374598
Name:BEHNAM KASHANCHI, M.D. INC.
Entity Type:Organization
Organization Name:BEHNAM KASHANCHI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-995-3900
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0629
Mailing Address - Country:US
Mailing Address - Phone:818-995-3900
Mailing Address - Fax:818-995-0208
Practice Address - Street 1:16133 VENTURA BLVD STE 415
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:310-858-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42282207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386674026Medicaid