Healthcare Provider Details

I. General information

NPI: 1467511592
Provider Name (Legal Business Name): HEALTHY HEART MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 VAN NUYS BLVD 104
PACOIMA CA
91331
US

IV. Provider business mailing address

18653 VENTURA BLVD 289
TARZANA CA
91356
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-5555
  • Fax: 818-899-5969
Mailing address:
  • Phone: 818-899-5555
  • Fax: 818-899-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARYOUSH YALLYA KASHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-899-5555