Healthcare Provider Details

I. General information

NPI: 1669907515
Provider Name (Legal Business Name): RUSTIN KASHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

1033 EUCLID ST #8
SANTA MONICA CA
90403-4234
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3381
  • Fax: 404-778-4295
Mailing address:
  • Phone: 650-823-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number101072
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: