Healthcare Provider Details

I. General information

NPI: 1063596625
Provider Name (Legal Business Name): ABBAS KASHANI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E NORTH ST 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 TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABBAS KASHANI
Title or Position: OFFICER
Credential: M.D.
Phone: 209-239-5665