Provider Demographics
NPI:1881008035
Name:KASSIM, ANISA (LAC, MPH)
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:KASSIM
Suffix:
Gender:F
Credentials:LAC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#514
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-822-7755
Mailing Address - Fax:
Practice Address - Street 1:143 CULVER BLVD
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7601
Practice Address - Country:US
Practice Address - Phone:310-822-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15977171100000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator