Healthcare Provider Details

I. General information

NPI: 1194368829
Provider Name (Legal Business Name): YASAMAN KAHROBAEI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4622
  • Fax: 559-448-4258
Mailing address:
  • Phone: 594-484-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34431TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34421TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: