Provider Demographics
NPI:1376954768
Name:HOUMAN M KASHANI, MD APC
Entity Type:Organization
Organization Name:HOUMAN M KASHANI, MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-622-3100
Mailing Address - Street 1:200 S BARRINGTON AVE
Mailing Address - Street 2:#49901
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7939
Mailing Address - Country:US
Mailing Address - Phone:213-207-6926
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84361261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A843610Medicaid
CA00A843610Medicaid