Healthcare Provider Details

I. General information

NPI: 1942499785
Provider Name (Legal Business Name): KIAN KAVEH DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N TENAYA WAY SUITE 200
LAS VEGAS NV
89128-1404
US

IV. Provider business mailing address

2451 HOLLOW ROCK CT
LAS VEGAS NV
89135-1510
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2225
  • Fax: 702-944-2228
Mailing address:
  • Phone: 702-755-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number718
License Number StateNV

VIII. Authorized Official

Name: KIAN KAVEH
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 702-944-2225