Provider Demographics
NPI:1932623659
Name:DEKEYAN, NSHAN D (DPM)
Entity Type:Individual
Prefix:
First Name:NSHAN
Middle Name:D
Last Name:DEKEYAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 TAMPA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1713
Mailing Address - Country:US
Mailing Address - Phone:818-697-8767
Mailing Address - Fax:818-657-8776
Practice Address - Street 1:7640 TAMPA AVE STE 106
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1713
Practice Address - Country:US
Practice Address - Phone:818-697-8767
Practice Address - Fax:818-657-8776
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5603213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program