MEDICARE: SARA KASHLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86091442	CA

General Provider Information

NPI Number	:	1932754801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA KASHLAN

Provider Business Mailing Address
First Line	:	1 VACAVILLE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-0915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 N BRAND BLVD STE 401
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1210
Country	:	US
Telephone Number	:	949-689-5039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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Directions to “ SARA KASHLAN ” Practice Location

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