Provider Demographics
NPI:1053451328
Name:KAVEH, KIAN (DO)
Entity type:Individual
Prefix:DR
First Name:KIAN
Middle Name:
Last Name:KAVEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5875 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2554
Mailing Address - Country:US
Mailing Address - Phone:702-804-0211
Mailing Address - Fax:702-853-4215
Practice Address - Street 1:3650 GEER RD
Practice Address - Street 2:STE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1148
Practice Address - Country:US
Practice Address - Phone:209-575-4575
Practice Address - Fax:209-575-4598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV718207RG0300X
CA20A11542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33747Medicare PIN
NVF65989Medicare UPIN