Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | E3975 | CA |
Y | 213ES0000X | Sports Medicine | E3975 | CA |
NPI | 1104998434 |
---|---|
Provider Name | Alona Kashanian |
First Address | Los Angeles, CA 90035-4003 |
Second Address | Los Angeles, CA 90037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U56666 | (02) | CA |