Healthcare Provider Details

I. General information

NPI: 1346634649
Provider Name (Legal Business Name): MARK A KASHTAN MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS ST # 21111
LOMA LINDA CA
92350-5400
US

IV. Provider business mailing address

11175 CAMPUS ST # 21111
LOMA LINDA CA
92350-5400
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4619
  • Fax:
Mailing address:
  • Phone: 909-558-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: