Provider Demographics
NPI:1295906402
Name:HEALTHY HEARTS MEDICAL GROUP INC
Entity type:Organization
Organization Name:HEALTHY HEARTS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARYOUSH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-899-5555
Mailing Address - Street 1:18653 VENTURA BLVD
Mailing Address - Street 2:289
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4103
Mailing Address - Country:US
Mailing Address - Phone:818-899-5555
Mailing Address - Fax:818-899-5969
Practice Address - Street 1:18308 SHERMAN WAY
Practice Address - Street 2:6
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4432
Practice Address - Country:US
Practice Address - Phone:818-881-8333
Practice Address - Fax:818-899-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666981Medicaid
CAG80771Medicare UPIN
CA00A666981Medicaid