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General NPI Number Information
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NPI Number | 1427589886
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Entity Type | Individual
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Provider Name | KIYON NASER-TAVAKOLIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 630 W 168TH ST MC28
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-305-5123
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Fax |
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Provider Business Mailing Address
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Address Line | 215 E 96TH ST APT 17L
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City | NEW YORK
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State | NY
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Zip | 10128-3947
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Country | US
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Telephone | 415-717-6649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA11671900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 316403
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA11671900
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 316403
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License Number State | NY
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