Healthcare Provider Details

I. General information

NPI: 1205515756
Provider Name (Legal Business Name): TOTAL WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16133 VENTURA BLVD STE 415
ENCINO CA
91436-2429
US

IV. Provider business mailing address

16133 VENTURA BLVD STE 415
ENCINO CA
91436-2429
US

V. Phone/Fax

Practice location:
  • Phone: 818-804-5177
  • Fax: 818-239-4239
Mailing address:
  • Phone: 818-804-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL KASHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 310-779-9480