Healthcare Provider Details

I. General information

NPI: 1013993252
Provider Name (Legal Business Name): PASADENA LASER AND SURGERY CENTER A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST SUITE 110
PASADENA CA
91106-2401
US

IV. Provider business mailing address

PO BOX 661120
ARCADIA CA
91066-1120
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-4866
  • Fax: 626-294-4872
Mailing address:
  • Phone: 626-294-4866
  • Fax: 626-294-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMIR KASHEFI
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 818-270-1280