Healthcare Provider Details

I. General information

NPI: 1588587026
Provider Name (Legal Business Name): KIMIA KASHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 E ALLUVIAL AVE STE 102
FRESNO CA
93720-3857
US

IV. Provider business mailing address

11213 N ALICANTE DR APT 212
FRESNO CA
93730-9778
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-9690
  • Fax:
Mailing address:
  • Phone: 916-370-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: