Healthcare Provider Details

I. General information

NPI: 1396004594
Provider Name (Legal Business Name): HIRSH KAVEESHVAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY STE B18
VALENCIA CA
91355-4456
US

IV. Provider business mailing address

10787 WILSHIRE BLVD APT 703
LOS ANGELES CA
90024-7340
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-7978
  • Fax: 661-288-7903
Mailing address:
  • Phone: 248-933-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number5101019962
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101019962
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number20A15212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: