Provider Demographics
NPI:1831657667
Name:KASIRI, ELNAZ (MD)
Entity type:Individual
Prefix:
First Name:ELNAZ
Middle Name:
Last Name:KASIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1966
Mailing Address - Country:US
Mailing Address - Phone:310-792-4067
Mailing Address - Fax:
Practice Address - Street 1:7345 MEDICAL CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1966
Practice Address - Country:US
Practice Address - Phone:310-792-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0608207RE0101X, 390200000X
CA192392207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program