Provider Demographics
NPI:1851335152
Name:KASSABIAN, CAROLYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:KASSABIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14901 RINALDI ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1204
Mailing Address - Country:US
Mailing Address - Phone:818-838-6070
Mailing Address - Fax:818-837-6832
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-838-6070
Practice Address - Fax:818-837-6832
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA80284207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19943Medicare ID - Type Unspecified