Healthcare Provider Details

I. General information

NPI: 1285752436
Provider Name (Legal Business Name): SHEIDA A KASHANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 BLOOMFIELD ST STE A
LOS ALAMITOS CA
90720-6702
US

IV. Provider business mailing address

PO BOX 41008
LONG BEACH CA
90853-1008
US

V. Phone/Fax

Practice location:
  • Phone: 562-716-7466
  • Fax:
Mailing address:
  • Phone: 562-716-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: