Provider Demographics
NPI:1336310887
Name:STEPAN KASIMIAN MD INC
Entity Type:Organization
Organization Name:STEPAN KASIMIAN MD INC
Other - Org Name:STEPAN O KASIMAIN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-720-6811
Mailing Address - Street 1:11645 WILSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6811
Mailing Address - Country:US
Mailing Address - Phone:310-996-0363
Mailing Address - Fax:310-996-0224
Practice Address - Street 1:3831 HUGHES AVE STE 105
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6834
Practice Address - Country:US
Practice Address - Phone:310-815-5035
Practice Address - Fax:310-558-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77961207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11643631OtherCAQH
CA1720003619OtherIND TYPE 1 NPI
CAA77961Medicare PIN
CA11643631OtherCAQH