=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851335152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN M KASSABIAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 01/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14901 RINALDI ST SUITE 305
-----------------------------------------------------
City | MISSION HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91345-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-838-6070
-----------------------------------------------------
Fax | 818-837-6832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14901 RINALDI ST SUITE 305
-----------------------------------------------------
City | MISSION HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91345-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-838-6070
-----------------------------------------------------
Fax | 818-837-6832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A80284
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------