Healthcare Provider Details

I. General information

NPI: 1003679168
Provider Name (Legal Business Name): SOUTH BAY VASCULAR SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST STE 110
TORRANCE CA
90505-4709
US

IV. Provider business mailing address

23560 MADISON ST STE 110
TORRANCE CA
90505-4709
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-6864
  • Fax: 424-999-2194
Mailing address:
  • Phone: 310-373-6864
  • Fax: 310-602-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIR KAVIANI
Title or Position: PRESIDENT
Credential: MD
Phone: 310-373-6864