=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104998434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALONA KASHANIAN DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3984 SOUTH FIGUEROA STREET
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-747-7272
-----------------------------------------------------
Fax | 213-747-0471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9629 CRESTA DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-747-7272
-----------------------------------------------------
Fax | 213-747-0471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0000X
-----------------------------------------------------
Taxonomy Name | Sports Medicine Podiatrist
-----------------------------------------------------
License Number | E3975
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------