Healthcare Provider Details

I. General information

NPI: 1003233834
Provider Name (Legal Business Name): KAVEH PANAHI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9179 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4912
US

IV. Provider business mailing address

9179 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4912
US

V. Phone/Fax

Practice location:
  • Phone: 623-439-2200
  • Fax: 623-439-7370
Mailing address:
  • Phone: 623-439-2200
  • Fax: 623-439-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: