Healthcare Provider Details

I. General information

NPI: 1295888022
Provider Name (Legal Business Name): KEVIN HAYAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15630 VENTURA BLVD
ENCINO CA
91436-3141
US

IV. Provider business mailing address

PO BOX 108
BEVERLY HILLS CA
90213-0108
US

V. Phone/Fax

Practice location:
  • Phone: 818-817-0600
  • Fax: 866-586-9678
Mailing address:
  • Phone: 310-975-1885
  • Fax: 866-586-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA70365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA70365
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA70365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: