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General NPI Number Information
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NPI Number | 1962821207
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Entity Type | Individual
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Provider Name | PEYMAN KANGAVARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 2801 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-1701
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Country | US
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Telephone | 562-933-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 8630 BURTON WAY APT 204
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City | LOS ANGELES
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State | CA
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Zip | 90048-3952
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Country | US
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Telephone | 310-801-1551
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Fax | 310-301-8751
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A142937
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License Number State | CA
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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 | A142937
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License Number State | CA
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