Provider Demographics
NPI:1861104671
Name:KASHANI, YASAMIN (DDS)
Entity type:Individual
Prefix:
First Name:YASAMIN
Middle Name:
Last Name:KASHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N CHURCH LN APT 618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2068
Mailing Address - Country:US
Mailing Address - Phone:714-757-7898
Mailing Address - Fax:
Practice Address - Street 1:721 W HUNTINGTON DR STE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6734
Practice Address - Country:US
Practice Address - Phone:626-574-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist