Provider Demographics
NPI:1417014036
Name:KARDASHIAN, JANE F (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:F
Last Name:KARDASHIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-435-0337
Mailing Address - Fax:559-435-2918
Practice Address - Street 1:6769 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3715
Practice Address - Country:US
Practice Address - Phone:559-435-0337
Practice Address - Fax:559-435-2918
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG439580207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG439580OtherSTATE LICENSE NUMBER