Healthcare Provider Details

I. General information

NPI: 1649237884
Provider Name (Legal Business Name): ABBAS KASHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E NORTH ST SUITE # 202
MANTECA CA
95336-4960
US

IV. Provider business mailing address

1234 E NORTH ST SUITE # 202
MANTECA CA
95336-4960
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-5665
  • Fax: 209-239-5285
Mailing address:
  • Phone: 209-239-5665
  • Fax: 209-239-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number203671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA82220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: