Provider Demographics
NPI:1184617763
Name:KASSABIAN, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:KASSABIAN
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 1:16542 VENTURA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4562
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-782-5041
Practice Address - Fax:818-205-9091
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74898207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA74898DMedicare PIN
CAHW13403AMedicare PIN
CAWA74898KMedicare PIN
CAHW13403Medicare PIN
CAWA74898EMedicare PIN
CAWA74898HMedicare PIN
CAWA74898IMedicare PIN
CAI11777Medicare UPIN
CAWA74898BMedicare PIN
CAWA74898CMedicare PIN