1023012374 NPI number — DR. KASRA RASTANI M.D., PH.D.

Table of content: DR. KASRA RASTANI M.D., PH.D. (NPI 1023012374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023012374 NPI number — DR. KASRA RASTANI M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASTANI
Provider First Name:
KASRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

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:
1023012374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 POST ST
Provider Second Line Business Mailing Address:
STE 848
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94102-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-781-7220
Provider Business Mailing Address Fax Number:
415-781-3513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 POST ST
Provider Second Line Business Practice Location Address:
STE 848
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94102-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-781-7220
Provider Business Practice Location Address Fax Number:
415-781-3513
Provider Enumeration Date:
06/01/2005

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: 207Y00000X , with the licence number:  A83012 , 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)