Healthcare Provider Details

I. General information

NPI: 1609715580
Provider Name (Legal Business Name): KIANA TAVAKOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SHADOW LANE, VALLEY HOSPITAL MEDICAL CENTER
LAS VEGAS NV
89106
US

IV. Provider business mailing address

9225 W CHARLESTON BLVD APT 2219
LAS VEGAS NV
89117-7064
US

V. Phone/Fax

Practice location:
  • Phone: 702-388-4000
  • Fax:
Mailing address:
  • Phone: 619-481-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL4607
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: