Healthcare Provider Details

I. General information

NPI: 1134494305
Provider Name (Legal Business Name): BANAFSHEH NOOSHA KASHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 MOULTON PKWY STE 205
LAGUNA HILLS CA
92653-1204
US

IV. Provider business mailing address

4014 LONG BEACH BLVD STE 210
LONG BEACH CA
90807-5409
US

V. Phone/Fax

Practice location:
  • Phone: 949-516-0150
  • Fax: 949-516-0140
Mailing address:
  • Phone: 562-997-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA120548
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA120548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: