Provider Demographics
NPI:1740374396
Name:KASIM, MEHMET (MD)
Entity type:Individual
Prefix:
First Name:MEHMET
Middle Name:
Last Name:KASIM
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 1:1508 W. VERDUGO AVE #C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-954-0208
Mailing Address - Fax:818-954-0029
Practice Address - Street 1:1508-1510 W. VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-954-0208
Practice Address - Fax:818-954-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334650Medicaid
CAA33465OtherCA STATE MEDICAL LICENSE
CAWA33465CMedicare ID - Type Unspecified
CA00A334650Medicaid