Healthcare Provider Details

I. General information

NPI: 1720003619
Provider Name (Legal Business Name): STEPAN KASIMIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EAST BROADWAY STE 201
GLENDALE CA
91205-1396
US

IV. Provider business mailing address

1101 EAST BROADWAY STE 201
GLENDALE CA
91205-1396
US

V. Phone/Fax

Practice location:
  • Phone: 213-361-7038
  • Fax: 818-500-9272
Mailing address:
  • Phone: 213-361-7038
  • Fax: 818-500-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA77961
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA77961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: