Provider Demographics
NPI:1568624997
Name:HOOSHMAND, KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:
Last Name:HOOSHMAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S BARRINGTON AVE
Mailing Address - Street 2:#14
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4429
Mailing Address - Country:US
Mailing Address - Phone:310-310-1566
Mailing Address - Fax:
Practice Address - Street 1:6020 SEABLUFF DR
Practice Address - Street 2:#1
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2252
Practice Address - Country:US
Practice Address - Phone:310-862-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11270208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1623Medicare UPIN