Ketamine Treatment Center

Primary specialty

Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X

Legal business name

KETAMINE TREATMENT CENTER

Practice address

6921-6923 Alabama Ave
Canoga Park, CA 91303

Phone

(818) 274-4609

NPI assigned

Apr 30, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Mirshojae

Title

Employee

Phone

(818) 606-2319

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1699522425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5985 TOPANGA CANYON BLVD",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913673623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6921-6923 ALABAMA AVE",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "91303",
            "telephone_number": "818-274-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "MIRSHOJAE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EMPLOYEE",
        "authorized_official_telephone_number": "818-606-2319"
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Denise Kendall
• Richard Kennedy
• Adriana Elisa Kenney, DDS
• Kyra Nicole Keresztes
• Anita Keshishi
• Artur Khachaturyan
• Sherif Zaki Khamis, M.D
• Mohammed Khan
• Rameesa Khan
• Rayesa Munir Khan, RPH

• Substance Use Disorder Rehabilitation Hospital Unit in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Substance Use Disorder Rehabilitation Hospital Unit in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.