Provider Demographics
NPI:1386847531
Name:KASHANI, DARYOUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYOUSH
Middle Name:
Last Name:KASHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18653 VENTURA BLVD
Mailing Address - Street 2:289
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4103
Mailing Address - Country:US
Mailing Address - Phone:818-899-5555
Mailing Address - Fax:818-899-5969
Practice Address - Street 1:8727 VAN NUYS BLVD
Practice Address - Street 2:101
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2451
Practice Address - Country:US
Practice Address - Phone:818-899-5555
Practice Address - Fax:818-899-5969
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA66698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666980Medicaid
CA00A666980Medicaid
CAG80771Medicare UPIN