Provider Demographics
NPI:1134347065
Name:KOUROSH A. KASHANI DDS, INC.
Entity type:Organization
Organization Name:KOUROSH A. KASHANI DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-265-0072
Mailing Address - Street 1:6585 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2706
Mailing Address - Country:US
Mailing Address - Phone:619-265-0072
Mailing Address - Fax:619-265-0073
Practice Address - Street 1:6585 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2706
Practice Address - Country:US
Practice Address - Phone:619-265-0072
Practice Address - Fax:619-265-0073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOUROSH A. KASHANI DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty