Healthcare Provider Details

I. General information

NPI: 1073208039
Provider Name (Legal Business Name): ALEXANDER CARRILLO-KASHANI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 940E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST STE 940E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: