MEDICARE: NSHAN D DEKEYAN DPM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	213E00000X	Podiatrist	E5603	CA

General Provider Information

NPI Number	:	1932623659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NSHAN D DEKEYAN DPM

Provider Business Mailing Address
First Line	:	7640 TAMPA AVE STE 106
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1713
Country	:	US
Telephone Number	:	818-697-8767
Fax Number	:	818-657-8776

Provider Business Practice Location Address
First Line	:	7640 TAMPA AVE STE 106
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1713
Country	:	US
Telephone Number	:	818-697-8767
Fax Number	:	818-657-8776

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	07/25/2021

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