Provider Demographics
NPI:1245459379
Name:KASHANCHI, MASSOUD (DDS)
Entity type:Individual
Prefix:DR
First Name:MASSOUD
Middle Name:
Last Name:KASHANCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MASSOUD
Other - Middle Name:
Other - Last Name:KASHANCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1503 S COAST DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1526
Mailing Address - Country:US
Mailing Address - Phone:714-662-4424
Mailing Address - Fax:714-546-0241
Practice Address - Street 1:1503 S COAST DR STE 110
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1526
Practice Address - Country:US
Practice Address - Phone:714-662-4424
Practice Address - Fax:714-546-0241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0303991223P0700X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0700XDental ProvidersDentistProsthodontics