Provider Demographics
NPI:1124117452
Name:KASHANI, HOOMAN (DO)
Entity type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:KASHANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S BEVERLY DR STE 720
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1180
Mailing Address - Country:US
Mailing Address - Phone:424-421-6001
Mailing Address - Fax:818-239-4239
Practice Address - Street 1:16133 VENTURA BLVD STE 415
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-624-5443
Practice Address - Fax:818-239-4239
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8543207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A8543Medicaid
CAW20A8543AMedicare PIN
CA0020A8543Medicaid