Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 030399 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 030399 | CA |
NPI | 1245459379 |
---|---|
Provider Name | Dr. Massoud Kashanchi |
First Address | Costa Mesa, CA 92626-1526 |
Second Address | Costa Mesa, CA 92626-1526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 26/11/2020 |