Healthcare Provider Details

I. General information

NPI: 1629635743
Provider Name (Legal Business Name): NICOLE KASHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 STATE ST STE B6
SANTA BARBARA CA
93110-1851
US

IV. Provider business mailing address

15477 VENTURA BLVD
SHERMAN OAKS CA
91403-3006
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-7144
  • Fax:
Mailing address:
  • Phone: 818-907-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA183314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: