Healthcare Provider Details

I. General information

NPI: 1508725367
Provider Name (Legal Business Name): KASEY KASRA MOTAMEDI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 E GARDEN VIEW DR
ANAHEIM CA
92808-1669
US

IV. Provider business mailing address

8751 E GARDEN VIEW DR
ANAHEIM CA
92808-1669
US

V. Phone/Fax

Practice location:
  • Phone: 714-906-4093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number95438174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95438174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: