Provider Demographics
NPI:1487681417
Name:KASSAN, ROB (MD)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:
Last Name:KASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6029 BRISTOL PKWY
Mailing Address - Street 2:100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6643
Mailing Address - Country:US
Mailing Address - Phone:310-417-5901
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:804 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1408
Practice Address - Country:US
Practice Address - Phone:310-395-5588
Practice Address - Fax:310-395-6313
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG67840CMedicare PIN
CAE83847Medicare UPIN