Healthcare Provider Details

I. General information

NPI: 1689307746
Provider Name (Legal Business Name): JASMINE KADOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 S HOOVER ST
LOS ANGELES CA
90007-1848
US

IV. Provider business mailing address

262 N CRESCENT DR APT 3F
BEVERLY HILLS CA
90210-4833
US

V. Phone/Fax

Practice location:
  • Phone: 213-622-3100
  • Fax:
Mailing address:
  • Phone: 310-985-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: