Healthcare Provider Details

I. General information

NPI: 1295906402
Provider Name (Legal Business Name): HEALTHY HEARTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18308 SHERMAN WAY 6
RESEDA CA
91335-4432
US

IV. Provider business mailing address

18653 VENTURA BLVD 289
TARZANA CA
91356-4103
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-8333
  • 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: DARYOUSH Y KASHANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-899-5555