Provider Demographics
NPI:1023059524
Name:ANDREW KASSINOVE, MD; INC.
Entity type:Organization
Organization Name:ANDREW KASSINOVE, MD; INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSINOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-951-1714
Mailing Address - Street 1:30925 GANADO DR
Mailing Address - Street 2:RANCHO PALOS
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6243
Mailing Address - Country:US
Mailing Address - Phone:310-951-1714
Mailing Address - Fax:
Practice Address - Street 1:2131 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1901
Practice Address - Country:US
Practice Address - Phone:213-484-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD6313OtherRAILROAD MEDICARE
CAWA73936FMedicare ID - Type Unspecified