Healthcare Provider Details

I. General information

NPI: 1659549400
Provider Name (Legal Business Name): JOHN KAYVANFAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E AVENUE S STE C
PALMDALE CA
93550-6180
US

IV. Provider business mailing address

PO BOX 260916
ENCINO CA
91426-0916
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-0078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA36821
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA36821
License Number StateCA

VIII. Authorized Official

Name: JOHN KAYVENFAR
Title or Position: OWNER
Credential: MD
Phone: 661-947-0078