Provider Demographics
NPI:1922549724
Name:ISAAC KAHEN KASHANI DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:ISAAC KAHEN KASHANI DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:KAHEN
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-751-5100
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:#510
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-751-5100
Mailing Address - Fax:818-714-2367
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:#510
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:818-751-5100
Practice Address - Fax:818-714-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty