Provider Demographics
NPI:1669907515
Name:KASHANI, RUSTIN (MD)
Entity type:Individual
Prefix:
First Name:RUSTIN
Middle Name:
Last Name:KASHANI
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 1:1033 EUCLID ST
Mailing Address - Street 2:#8
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4234
Mailing Address - Country:US
Mailing Address - Phone:650-823-6676
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-778-3381
Practice Address - Fax:404-778-4295
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101072207YX0901X
IAMD-50145207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology