Provider Demographics
NPI:1639844194
Name:NSHAN D DEKEYAN DPM
Entity Type:Organization
Organization Name:NSHAN D DEKEYAN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NSHAN
Authorized Official - Middle Name:DAVET
Authorized Official - Last Name:DEKEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-697-8767
Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6402
Mailing Address - Fax:316-284-6402
Practice Address - Street 1:19300 RINALDI ST UNIT 7554
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91327-8828
Practice Address - Country:US
Practice Address - Phone:818-697-8767
Practice Address - Fax:818-657-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5603OtherLICENSE