MEDICARE: DR. NUSHKA KASSEM N.D, L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC-13363	CA
2	175F00000X	Naturopath	ND-210	CA

General Provider Information

NPI Number	:	1033469911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NUSHKA KASSEM N.D, L.AC

Provider Business Mailing Address
First Line	:	1375 E 6TH ST STE 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1251
Country	:	US
Telephone Number	:	213-327-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 E 6TH ST STE 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1251
Country	:	US
Telephone Number	:	213-327-4586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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