Provider Demographics
NPI:1720003619
Name:KASIMIAN, STEPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPAN
Middle Name:
Last Name:KASIMIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 EAST BROADWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1396
Mailing Address - Country:US
Mailing Address - Phone:213-361-7038
Mailing Address - Fax:818-500-9272
Practice Address - Street 1:1101 EAST BROADWAY
Practice Address - Street 2:STE 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1396
Practice Address - Country:US
Practice Address - Phone:213-361-7038
Practice Address - Fax:818-500-9272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77961207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery