Healthcare Provider Details

I. General information

NPI: 1598025256
Provider Name (Legal Business Name): LEILA KASHANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEILA KASHANI-GHARAVI

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

IV. Provider business mailing address

710 KRESSON RD
CHERRY HILL NJ
08003-2604
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-4774
  • Fax: 660-827-8992
Mailing address:
  • Phone: 856-795-3320
  • Fax: 856-795-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB09751400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017044049
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: