Provider Demographics
NPI:1962566851
Name:KASHANCHI, BAHRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:BAHRAM
Middle Name:
Last Name:KASHANCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20576 CALIFA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5310
Mailing Address - Country:US
Mailing Address - Phone:818-881-3822
Mailing Address - Fax:
Practice Address - Street 1:6670 RESEDA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5327
Practice Address - Country:US
Practice Address - Phone:818-881-3822
Practice Address - Fax:818-881-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK34131-01OtherMEDICAL PROVIDER