Healthcare Provider Details

I. General information

NPI: 1932690674
Provider Name (Legal Business Name): ROJAN KAVOSH MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

7064 VIA DEL RIO
SAN JOSE CA
95139-1137
US

V. Phone/Fax

Practice location:
  • Phone: 408-623-8596
  • Fax:
Mailing address:
  • Phone: 408-623-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: