Healthcare Provider Details

I. General information

NPI: 1407234495
Provider Name (Legal Business Name): MR. KAYVON AMIR AKBARIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. KEVIN AMIR VAGHAR

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N MAIN ST
FLORENCE MA
01062-1287
US

IV. Provider business mailing address

190 FLORENCE AVE
ARLINGTON MA
02476-7236
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-5382
  • Fax:
Mailing address:
  • Phone: 339-223-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: