=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730625765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUMAN M KASHANI, MD APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2017
-----------------------------------------------------
Last Update Date | 01/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2214 S HOOVER ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90007-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-622-3100
-----------------------------------------------------
Fax | 866-867-2392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 49901
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-0901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-622-3100
-----------------------------------------------------
Fax | 866-867-2392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOUMAN M KASHANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 213-622-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A84361
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------