Healthcare Provider Details

I. General information

NPI: 1467448100
Provider Name (Legal Business Name): MASOOM M KANDAHARI MD FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 116
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

31860 PASEO NAVARRA
SAN JUAN CAPISTRANO CA
92675-3651
US

V. Phone/Fax

Practice location:
  • Phone: 951-234-7006
  • Fax: 951-225-9938
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101040044
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: