1437232584 NPI number — MRS. SANDY KASHANI LARI OPTOMETRIST

Table of content: MRS. SANDY KASHANI LARI OPTOMETRIST (NPI 1437232584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437232584 NPI number — MRS. SANDY KASHANI LARI OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARI
Provider First Name:
SANDY
Provider Middle Name:
KASHANI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OPTOMETRIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437232584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11680 MONTANA AVE APT 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-207-1006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 WESTWOOD BVLD
Provider Second Line Business Practice Location Address:
SUITE # 107
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-234-8790
Provider Business Practice Location Address Fax Number:
310-441-1609
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11437T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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