Healthcare Provider Details

I. General information

NPI: 1265310940
Provider Name (Legal Business Name): KAILYN SIMONE QUASH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 270
SANTA MONICA CA
90404-2053
US

IV. Provider business mailing address

920 ENTERPRISE AVE APT 8
INGLEWOOD CA
90302-8321
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-8585
  • Fax:
Mailing address:
  • Phone: 562-505-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95036605
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036605
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95205984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: