Provider Demographics
NPI: | 1861495475 |
---|---|
Name: | KASHYAP, ASHWIN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ASHWIN |
Middle Name: | |
Last Name: | KASHYAP |
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: | PO BOX 512185 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90051-0185 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 425 HAALAND DR STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | THOUSAND OAKS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91361-5230 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-496-2949 |
Practice Address - Fax: | 805-204-4076 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-05-27 |
Last Update Date: | 2022-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A52406 | 207RX0202X, 207RH0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 1417145673 | Medicaid | |
CA | 1861495475 | Medicaid | |
CA | 1417145673 | Medicaid | |
CA | 1861495475 | Medicaid |