Healthcare Provider Details

I. General information

NPI: 1104756287
Provider Name (Legal Business Name): KIMYA GHAFFARIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 DEL PRADO BLVD S STE 4
CAPE CORAL FL
33990-2676
US

IV. Provider business mailing address

25522 NOTTINGHAM CT
LAGUNA HILLS CA
92653-7501
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-2000
  • Fax:
Mailing address:
  • Phone: 949-735-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: