Healthcare Provider Details

I. General information

NPI: 1417189341
Provider Name (Legal Business Name): HEALTHY HEARTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 VAN NUYS BLVD 101
PANORAMA CITY CA
91402-2451
US

IV. Provider business mailing address

8727 VAN NUYS BLVD 103
PANORAMA CITY CA
91402-2451
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-6414
  • 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 NumberA66698
License Number StateCA

VIII. Authorized Official

Name: DARYSOUH Y KASHANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-899-5555